Whether Pre-Term Caesarean Section is Necessary Because of Urinary Tract Dilatation?

László SZABÓ1,7,8, Zsuzsanna SZÉKHELYI2,
Péter BERKÕ3,7, Béla LOMBAY4,7, Gyula RÉTI5,
András KISS6, Miklós MERKSZ6

1Pediatric Nephrology, Borsod County University Hospital, Miskolc, Hungary
2Neonatology, Borsod County University Hospital, Miskolc, Hungary
3Gynecology and Maternity Centre, Borsod County University Hospital, Miskolc, Hungary
4Pediatric Radiology, Borsod County University Hospital, Miskolc, Hungary
5Pediatric Surgery and Urology, Borsod County University Hospital, Miskolc, Hungary
6Pediatric Urology, Heim Pál Children’s Hospital, Budapest, Hungary
7Faculty of Health Science, University of Miskolc, Miskolc, Hungary
8Postgraduate Institute of Child Health, University of Debrecen, Miskolc, Hungary

Hypothesis: Pre-term caesarean section is unrequired in order to
enable the operation of dilatation of urinary tract in neonate.

Methods: A retrospective analysis of the patients of two large casevolume
paediatric institutions. In a period of 5 years, 329 neonates
were followed due to intrauterine diagnosis of urinary tract dilatations
(197 at the Department of Urology, Heim Pál Children’s Hospital in
Budapest, whereas in Miskolc 132), including 13 cases where the urological
anomaly was the indication for pre-term induction of labour.

Results: Of the 13 neonates who had been delivered prematurely,
none were operated before the postconceptional age of 40 weeks,
and 3 subsequently required no surgical intervention. Two
neonates developed life-threatening conditions that presumably
could have been avoided without the premature caesarean section.

Conclusions: There are several arguments against pre-term delivery:
1. Prenatal diagnostics does not always yield as accurate information
as the diagnostic procedures performed in infancy; 2.
Intrauterine urinary tract dilatation often resolve spontaneously,
superseding the need for both pre- and post-natal surgical interventions.
3. Scientific observations have confirmed that there is no difference
between the efficacy of postnatal and pre-term interventions.
Based on the above-mentioned, authors emphasize that this
outdated practice can no longer be accepted, and call for good
cooperation between the obstetrician, the paediatric urologist and
nephrologist, to coordinate the management of the case.