Now that life is back to normal and I’m all done hyperventilating, here is the update to our 20-week ultrasound that showed a dialated renal pelvis (fancy medical term: pelvicaliectasis)

After the 20-week ultrasound, we were asked to return in three weeks for a second ultrasound to see if anything had changed. Last week, that ultrasound revealed that the renal pelvis continued to be abnormal.

As at the previous ultrasound, the technician wouldn’t give me any information. So, when he left the room to show the measurements to the doctor and get further instructions, I lept off the examination table and recorded a voice memo of all the measurements and notes that were left visible on the computer screen. For the first few days until they had written up my results and sent them to my midwives, who then delivered them to me by phone, that was all the information I had.

I plugged those measurements into Google and found a few medical journal articles and the like suggesting that this was fairly a mild case of pelvicaliectasis, which might resolve on its own after birth. It could also lead to kidney infections and other no-fun complications in affected newborns who might, at worst, need antibiotics and corrective surgery. Not great news, but not the worst either.

The most awesome medical journal article ever, covering this very topic, is entitled “Mild fetal renal pelvis dilatation: much ado about nothing?” The authors can’t stop making Shakespeare references:

To screen, or not to screen, that is the question:
Whether ’tis nobler in the nephron to suffer
The slings and arrows of outrageous infection,
Or to weight obstruction against a sea of refluxes,
And, by meds or surgery end them?
To flow, to reflux no more,
and by clinical trial to say we end the loin-ache
and thousand p-values that medicine is heir to,
‘tis evidence-based practice devoutly to be wish’d.

Extreme dorkiness aside, assuming that I understand it correctly and it is actually relevant in this case, the article suggests that relatively mild cases of prenatal renal pelvic dialation aren’t necessarily that big a deal. So we felt a little better.

But then!

The hospital’s very sympathetic Medical Genetics people called last Friday to explain that sometimes renal pelvis abnormalities are also markers for a genetic disorder, which can be life-limiting or maybe even “incompatible with life”.

Angst!

On Monday, we were given the option to have an amniocentesis to find out for sure. Amnio is pretty high risk at this point in pregnancy, as it can cause premature labour, which would really, really suck at 23 weeks, as the fetus is just barely, maybe viable. But since the fetus’ risk of a genetic disorder was estimated to be much higher than the risk of an amnio, we decided to go with the test, and at least have our answer.

I didn't look, but believe the needle used for amniocentesis was about this size.

After the needle in the belly, I went on bed rest for 24 hours and restricted movement for another day to reduce the risk of early labour. (Due to cramps that have scared the crap out of me as recently as yesterday, I’m still walking like a really old person and avoiding exercise even more diligently than usual.)

The hospital ordered FISH results, which are an early response to the part of the amnio that tests for the most common genetic disorders, the same ones that babies with pelvicaliectasis are at elevated risk for. They called yesterday to say that the baby does NOT have one of those genetic disorders. ( \Thank you, hospital, because I would have lost my mind spending two weeks waiting for those results. We’ll get the complete results in another 10 days, but since there is no elevated risk for those other disorders, we are not worried.)

So, it’s “only” a kidney problem. Even if the kid ends up with malfunctioning kidneys, infections, and needs surgery as a newborn, he does not have a systemic, life-threatening or life-limiting genetic disorder.

In a month or so, we get to go see a pediatrician who will hopefully have some more information about post-natal prognosis and possible treatment options. But, as the geneticist told me over the phone, whatever it ends up being, it’s just plumbing. It can be fixed with medicine and surgery.

Perspective: hooray!

After a few days of serious anxiety and feeling like maybe we should stop hoping for, looking forward to, and bonding with this kid, we are now back to contentedly considering names, getting ready to build the crib, and buying postpartum cloth pads on the Internet. (OK, maybe that last one is just me.)

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