Evaluation of nephroamnial bypass efficiency in a fetus with obstructive uropathies

Aim: to evaluate efficiency of intrauterine nephroamnial bypass in a fetus to manage obstructive uropathies and to discuss obstetric tactics Materials and Methods: 57 patients with obstructive fetal uropathy were managed in the Ural Research Institute for Maternal and Infant Health from 2018 to 2022. During the study, the patients were divided into two groups: a main group and a comparison group. In the main group (n=37), fetal hydronephrosis (grades III–IV) had ultrasound signs of preserved kidney function. Along with this, fetal urinary system was decompensated in the comparison group (n=20). All fetuses underwent ultrasonic examination and magnetic resonance imaging. To assess preservation of kidney function, a complete clinical, laboratory and ultrasound examination of children was performed in the early neonatal period and within the 1st year of life Results: on average, congenital fetal urinary malformations were detected at 20–21 weeks of pregnancy. The period of admission to an obstetric hospital level 3 is 26–28 weeks. All patients of the main group underwent intrauterine nephroamnial bypass (in most cases, at 22–32 weeks of pregnancy). During a follow-up of a fetal urinary system, reliable ultrasound signs of efficient nephroamnial bypass (i.e., complete void of renal collecting system, increased thickness of renal parenchyma) were detected. Stent migration (16,2%), premature labor (21,6%), and premature discharge of amniotic fluid (13,5%) are complications of nephroamnial bypass. In the comparison group, indicators of pregnancy course and outcomes are worse than those in the main group. Most of the main group patients were delivered at full-term pregnancy, while premature births were reported in 50% of the comparison group. Evaluation of the early neonatal period and the first year of life demonstrated that incidence of chronic renal failure and secondary shrunken kidney is significantly higher in the comparison group Conclusion: in the authors' opinion, early prenatal diagnosis, as well as timely intrauterine and postnatal surgical treatment can help to prevent complications and to maintain normal functional activity of the urinary system in a newborn which is a priority factor. KEYWORDS: obstructive uropathies, intrauterine nephroamnial bypass, renal failure, secondary shrunken kidney. FOR CITATION: Kosovtsova N.V., Fyodorova N.A. Evaluation of nephroamnial bypass efficiency in a fetus with obstructive uropathies. Russian Journal of Woman and Child Health. 2025;8(2):94–99 (in Russ.). DOI: 10.32364/2618-8430-2025-8-2-1