**5.3. Bladder exstrophy**

Often the diagnosis of bladder exstrophy is made by prenatal ultrasound and, in some cases, may be confirmed by MRI. In the event that a prenatal diagnosis is not made, the diagnosis should be clinically apparent and recognizable at birth in the delivery room [81]. If a prenatal diagnosis is not made, the diagnosis of bladder exstrophy should be clinically recognizable at delivery. A careful physical examination will differentiate bladder exstrophy from other congenital anomalies that involve abdominal wall defects, such as omphalocele, gastroschisis, and cloacal exstrophy.

saline-soaked sterile dressings should be applied over the exposed bladder and bowel mucosa and covered with plastic wrap to minimize insensible fluid and heat loss. Survival rates of 80–100% have been reported, but quality of life (e.g., bowel, urinary, and sexual

Management of Pregnancy and Delivery in Prenatally Diagnosed Congenital Anomalies

http://dx.doi.org/10.5772/intechopen.71802

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Congenital anomalies of the kidney and urinary tract (CAKUT) constitute approximately 20–30% of all anomalies identified in the prenatal period [84]. Defects can be bilateral or unilateral, and different defects often coexist in an individual child. In general, the optimal timing recommended for a screening antenatal ultrasound is between 16 and 20 weeks of gestation because of the following factors at this gestational age. Counseling of families with fetuses with CAKUT should be universally available. If the fetal prognosis is poor, as determined by severe bilateral disease, bilateral RA, oligohydramnios, or unfavorable amniotic fluid analysis, legal termination, if possible, can be offered. In all other cases, continued counseling throughout the pregnancy including discussion of postnatal management is required. In particular, discussion with parents regarding their wishes on the level of support given to offspring with severe oligohydramnios, who are at risk for lung hypoplasia that may be incompatible with life, is helpful in establishing guidelines for initial

• Assessment of amniotic fluid volume and analysis of biochemical markers are used to evaluate fetal renal function. By 20 weeks of gestation, fetal urine accounts for more than 90% of the amniotic fluid volume. Thus, a decrease in amniotic fluid volume (oligohydramnios) at or beyond the 20th week of gestation is an excellent predictor of abnormal fetal renal function and CAKUT [84]. Severe oligohydramnios due to CAKUT either involves both kidneys or occurs in a solitary kidney in the fetus. Bilateral renal agenesis (RA) or severe dysgenesis, bilateral ureteric obstruction, or obstruction of the bladder outlet or urethra can result in severe oligohydramnios as early as 18 weeks of gestation. Because an adequate amniotic fluid volume is critical for lung development, severe oligohydramnios due to abnormal fetal renal function in the second trimester can result in lung hypoplasia, a

• Assessment for additional anomalies. Potter's syndrome consists of a typical facial appearance characterized by pseudoepicanthus, recessed chin, posteriorly rotated, flattened ears and flattened nose, decreased fetal movement, musculoskeletal features including clubfoot and clubhand, hip dislocation and joint contractures, and pulmonary

• Analysis of amniotic fluid. Although oligohydramnios is the most reliable predictor of abnormal fetal renal function, its absence does not assure normal fetal renal function.

**6. Congenital anomalies of the kidney and urinary tract**

function) is a concern [82].

**6.1. Pregnancy management**

postnatal care [84].

potentially fatal disorder.

hypoplasia.

Following the prenatal diagnosis of bladder exstrophy, prenatal care includes the following [16, 81]:


The cesarean delivery should be reserved for obstetrical complications.
