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28 weeks pregnant and had shunt put in baby's bladder. What are the chances of this working?

Mar 2013
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I am 28 weeks pregnant & just had a shunt put in ny baby's bladder. what are the chances of this working?
Posted Wed, 9 Oct 2013 in Pregnancy
Answered by Dr. Aarti Abraham 1 hour later
Brief Answer:

Detailed Answer:
Thanks for writing to us with your health concern.
Normally, the shunt put in the bladder of the fetus in utero is called a vesico amniotic shunt ( connecting the urinary bladder of the fetus with the amniotic cavity ).
This is used to treat LUTO ( lower urinary tract obstructions ) - a birth defect that results in obstruction of the urinary tract, thus distension of the bladder. It is a serious condition because back pressure can damage the kidneys , and due to less urine excreted, amniotic fluid levels decrease ( urine contributes significantly to amniotic fluid ) - and thus the baby cannot grow well in the absence of adequate fluid, and most importantly, lungs cannot expand, leading to pulmonary hypoplasia.
There could be various causes for LUTO ( valves in the urethra, non development of urethra , stricture etc ) and the success of the shunt depends on the exact cause, as some maybe surgically manageable after delivery, and others might not be amenable to treatment.
Also, if a shunt was put, that generally means that the situation was reversible. If irreversible renal damage ( cysts in kidneys, extremely low amniotic fluid levels ) are observed, then shunt therapy is not carried out.
Hence, if you provide me further details such as
- antenatal diagnosis on ultrasound which required shunt surgery
- latest amniotic fluid levels and baby's growth status on ultrasound
- results of karyotyping and chromosomal analysis ( this should be, and generally, is done, as many urinary tract defects are associated with chromosomal abnormalities also )
The chances of shunt surgery being successful are quite good, because studies have shown clear improvement after delivery in babies where the shunt was inserted during pregnancy.
However, you would require weekly follow up, as such shunts might be displaced in upto 40 % of cases, and then, would require re insertion.
Serial ultrasounds would show improvement in amniotic fluid volume, and let you know how well the procedure is working in your case ( good results can be expected ).
Post birth, the baby is transported to a NICU ( neonatal Intensive Care Unit ) and thoroughly assessed for renal damage, actual abnormality causing obstruction and function of the lungs. Adequate ventilatory support is provided if required.
The condition is then corrected surgically if possible ( for eg. laser treatment for urethral valves ) , in more complicated cases, more extensive bladder and urethral surgery is undertaken once the baby survives the acute post delivery phase.
Babies with LUTO are more prone than others to develop long term sequelae such as renal damage, chronic renal infections, chronic renal failure, respiratory complications such as asthma due to improper lung development, failure to grow properly etc.
They have to be intensively monitored for the first 5 years of their life by a paediatrician in concert with a nephrologist to assess and rectify such complications.
As you can see, the course ahead depends on the exact pathology present in your case, and on the long term course that your baby would take.
I hope this answer helped to clear the picture for you.
I wish you all the best for this pregnancy and motherhood.
I would be happy to address any follow up questions that you might have.
Take care.
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