Lethal fetal renal anomalies and obstetric outcome

The incidence of prenatal and intrapartum complications was examined among 33 pregnancies complicated by lethal fetal renal abnormalities (cases) and compared to 200 contemporaneous control pregnancies (controls) by retrospective record review. Cases experienced higher rates of antepartum bleeding (29% vs. 6%, p<0.0001) stillbirth (15% vs. 0%, p<0.0001), preterm birth (34.3±4.1 vs. 39.7±1.8, p<0.0001) and breech presentation (48% vs. 4%, p<0.0001). Twenty-six of 33 cases had lung weights ≤ first centile. Primary cesarean section occurred more frequently in cases than in controls (48% vs. 9%, p<0.0001). Knowledge of poor fetal prognosis alone did not appear to influence obstetrical management. We conclude that timely consultation with sonologist and neonatologist and patient counseling may avoid unnecessary obstetrical intervention when pregnancy complications occur. Pregnancies complicated by lethal fetal renal abnormalities have higher rates of ante- and intrapartum complications leading to frequent abdominal delivery. This suggests that accurate predictive markers for lethal fetal renal disease may reduce ineffective obstetric intervention.