Complex Fetal Care Case: Amniotic Fluid Replacement in Severe Bladder Outlet Obstruction

* Abbreviations: CPAP: : continuous positive airway pressure MRI: : magnetic resonance imaging TLV: : total lung volume A 32-year-old gravida 4, para 2-1-0-3 woman was referred to the Cincinnati Fetal Center at 20 5/7 weeks’ gestation for a diagnosis of fetal bladder outlet obstruction and anhydramnios. Her obstetric history was significant for 3 cesarean deliveries. Her medical history was noncontributory, and her only medication was prenatal vitamins. Family history included a paternal male cousin with a “partially blocked urethra” as a teenager, and a paternal female cousin with an unknown kidney issue requiring hospitalization; however, the family was unable to provide further information. Prenatal laboratory testing was unremarkable except for rubella-nonimmune status. Fetal imaging at the referring obstetrician’s office at 19 1/7 weeks’ gestation showed anhydramnios, suspected bladder outlet obstruction, absent left kidney, echogenic right kidney, and a pericardial effusion. An amniocentesis had not been performed, and noninvasive prenatal genetic screening result was consistent with a male fetus with low risk for trisomy 13, 18, and 21, monosomy X, and triploidy. A multidisciplinary team reviewed her records and imaging at 21 6/7 weeks’ gestation, and proceeded with the following evaluations