Question:medium
Foetal hydronephrosis is diagnosed in the mother at 34 weeks of gestation. The amniotic fluid is normal. Which of the following is the most appropriate management?
Foetal hydronephrosis is diagnosed in the mother at 34 weeks of gestation. The amniotic fluid is normal. Which of the following is the most appropriate management?
Show Hint
Normal amniotic fluid means the kidneys are still functioning; no need for early delivery or fetal intervention.
Updated On: Jul 8, 2026
- Fetal intervention to decompress hydronephrotic kidney
- Premature termination of pregnancy followed by pyeloplasty
- Delivery at term followed by radiological examination
- Delivery at term followed by pyeloplasty
Show Solution
The Correct Option is C
Solution and Explanation
Step 1: Read the clue given by the amniotic fluid.
Amniotic fluid late in pregnancy comes mostly from fetal urine. Normal fluid at 34 weeks means both kidneys, working together, are still producing urine well, so there is no severe obstruction putting the baby at immediate risk.
Step 2: Ask if the baby needs to be treated before birth.
Procedures done inside the womb to relieve a blocked kidney are kept for babies with low fluid and a failing kidney, since that combination threatens lung development and kidney survival. That danger sign is missing here, so there is no case for fetal surgery or for delivering the baby early.
Step 3: Plan care after this point.
Let the pregnancy run its full course to term, avoiding the extra risks of prematurity. Once the baby is born, image the kidneys properly, an ultrasound scan first, sometimes repeated after a week or so because a newborn's mild dehydration can hide the true degree of swelling, and add further studies such as a voiding study or a renogram if the ultrasound looks worrying. Surgery is only planned once these tests show a real, obstructing problem.
Step 4: Weigh the other choices.
Decompressing the kidney before birth is overtreatment when the fluid is normal. Ending the pregnancy early just to operate sooner trades a mild, unconfirmed kidney finding for the real complications of prematurity. Operating right after term birth, without imaging first, risks operating on a kidney that may not even need surgery.
Step 5: Give the answer.
$\text{Delivery at term followed by radiological examination}$ balances safety for the baby with proper diagnosis before any operation.
\[ \boxed{\text{Delivery at term followed by radiological examination}} \]
Amniotic fluid late in pregnancy comes mostly from fetal urine. Normal fluid at 34 weeks means both kidneys, working together, are still producing urine well, so there is no severe obstruction putting the baby at immediate risk.
Step 2: Ask if the baby needs to be treated before birth.
Procedures done inside the womb to relieve a blocked kidney are kept for babies with low fluid and a failing kidney, since that combination threatens lung development and kidney survival. That danger sign is missing here, so there is no case for fetal surgery or for delivering the baby early.
Step 3: Plan care after this point.
Let the pregnancy run its full course to term, avoiding the extra risks of prematurity. Once the baby is born, image the kidneys properly, an ultrasound scan first, sometimes repeated after a week or so because a newborn's mild dehydration can hide the true degree of swelling, and add further studies such as a voiding study or a renogram if the ultrasound looks worrying. Surgery is only planned once these tests show a real, obstructing problem.
Step 4: Weigh the other choices.
Decompressing the kidney before birth is overtreatment when the fluid is normal. Ending the pregnancy early just to operate sooner trades a mild, unconfirmed kidney finding for the real complications of prematurity. Operating right after term birth, without imaging first, risks operating on a kidney that may not even need surgery.
Step 5: Give the answer.
$\text{Delivery at term followed by radiological examination}$ balances safety for the baby with proper diagnosis before any operation.
\[ \boxed{\text{Delivery at term followed by radiological examination}} \]
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