Conservative management for fetal megacystis: A clinical based approach

Abstract

Background: Fetal megacystis is an enlargement of the fetal urinary bladder that is a rare ultrasonography finding during routine antenatal screening. Though intrauterine genetic screening is widely used to determine the prognosis of this condition in resource rich settings, in the developing world, clinician often has to rely on clinical judgement for proper counselling and management of women with such foetal presentations. Case presentation: We present a case of a 31 years old lady who presented at our facility as a referral case at a gestational age of 25 weeks for termination of pregnancy due to an incidental ultrasonography finding of an enlarged fetal urinary bladder with oligohydramnious. Initial evaluation at our facility led to diagnosis of foetal megacystis with no other congenital anomalies. An informed expectant management was carried out under close follow up and finally delivered a 4.2 kg baby by caesarean section at 39 weeks. The baby is currently 4months of age, with normal renal function parameters on routine care and urological follow up. Conclusion: Foetal megacystis is a rare condition with diverse aetiology. Genetic screening for chromosomal anomalies is a major prognostic indicator however in resource limited setup, a clinician has to rely on clinical judgement to provide the patient with the necessary information to make an informed decision between expectant management or termination of pregnancy.