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Prognostic Uncertainty and Shared Care Planning: A Case of a Fetus With Severe Renal Hypoplasia and Early Anhydramnios
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Prognostic Uncertainty and Shared Care Planning: A Case of a Fetus With Severe Renal Hypoplasia and Early Anhydramnios
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Journal Article
Prognostic Uncertainty and Shared Care Planning: A Case of a Fetus With Severe Renal Hypoplasia and Early Anhydramnios
2025
Overview
Introduction: Fetal renal hypoplasia, often associated with oligoanhydramnios, can lead to significant clinical complications, such as pulmonary hypoplasia, severe prematurity, or intrauterine death. The literature indicates that in many cases, pregnancies are terminated in the presence of anhydramnios, oligoanhydramnios, or pPROM without a thorough assessment of the care needs of the unborn child. At the Policlinico \"A. Gemelli,\" a Perinatal Hospice team employs an interdisciplinary approach that lead to Shared Care Planning (SCP). This process was supported by the involvement of clinical ethics consultants. Aims: To develop a more comprehensive intervention strategy in situations of prognostic uncertainty, such as early anhydramnios. Methods: We present a clinical case involving a fetus with severe renal hypoplasia and early anhydramnios beginning at the 19th week of gestation. The case was evaluated comprehensively by the Perinatal Hospice team, with the support of clinical ethics consultants, leading to the development of a SCP. Results: The prognostic uncertainty related to the severe fetal condition combined with the absence of a prenatal genetic diagnosis, prompted the multidisciplinary team to carefully evaluate the proportionality of intensive care measures in the delivery room. At 36 weeks, the ultrasound visualization of a small pocket of amniotic fluid led to the decision to provide intensive respiratory support at birth, with plans to reassess its proportionality after delivery. Upon birth, the newborn received invasive respiratory assistance and demonstrated spontaneous urination. She is currently breathing autonomously and undergoing peritoneal dialysis due to elevated creatinine levels. Conclusions: The prognostic uncertainty associated with early oligoanhydramnios and the potential severe pulmonary hypoplasia necessitates a multidisciplinary approach to assess possible outcomes. This process involves an ethical-clinical reflection to evaluate the proportionality of intensive treatments to be offered to the child. The SCP can help to ensure the best interest of both the mother and the baby.
Publisher
MedStar Washington Hospital Center
Subject
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