On one of our early ultrasounds, one of our boys, Judah, or "Twin A" was diagnosed with Hydronephrosis. At first this was of little concern. It is the most common prenatally diagnosed abnormality, occurs in 1-5% of pregnancies, and most often resolves on its own shortly after birth. The link has more detailed information on the definition of hydronephrosis, but to put it shortly, it is urine that collects in the kidney and is unable to drain into the bladder like it's suppose to. It can be cause by either reflux of urine back up from the bladder, or from some sort of kink or obstruction in the ureter. Since this condition is fairly common and the dilation amount was very mild, we were not very concerned. Well, my latest ultrasound showed a very large increase in the dilation of Judah's left kidney. Apparently the amount of increase in the dilation was enough to cause quite the concern.
The ultrasound tech was the first one to freak me out. While measuring the dilation of the kidney, she mentioned that it was very dilated and asked me if the doctors planned to deliver the babies early to fix the kidney. I told her no, and then proceeded to silently think of all the little preemie babies that I take care of that have to be on oxygen for months before they get to go home because they were delivered too early, before their little lungs were ready to handle extra-uterine life. The ultrasound tech finished measuring and left to get a doctor. Some doctor that I have never seen came in and told me that he is concerned about the future function of Judah's kidney and that he was going to refer me to a urologist to get a second opinion on whether or not immediate action needs to be taken. He also mentioned the possibility of taking the babies out early to intervene.
I think I cried on the way home.
How early are they going to take them?
Why are they so worried about this since his other kidney is working great and my amniotic fluid levels are perfect?
Is he constantly in pain because of this?
Will he have to have surgery?
He lungs won't do well during surgery if they have to take him early.
They need to at least be 33-34 weeks before they take them.
How long will we have to be in the NICU?
How will this affect breastfeeding?
If they take them early, that means a c-section.
I don't want the first few weeks with my boys to be spent in the hospital.
Those are all the thoughts that kept running through my head for the next 5 days. I told Jeremy about the situation and he also became very worried and upset. Over the next few days, we both did research on hydronephrosis and treatments. From what we found, most cases that did not self-resolve after birth, surgery would need to be done to fix the obstruction causing hold-up of urine. In everything that we read, there were no cases where the babies needed to be delivered early. This only needed to be done if the abnormality affected both kidneys, and if amniotic fluid was low. But this was not our case. Judah's other kidney was of normal size, and my amniotic fluid was completely normal. This was a tiny bit reassuring, but we were still worried because both the ultrasound tech and the OB that I saw mentioned early delivery. The other option was to do antenatal surgery (Going through my belly into Judah to drain urine). This was not something we wanted to happen either. We tried to just not think about it a whole lot until we talked to the specialist.
We finally went to see the urologist. He was extremely reassuring. He described how the ultrasound techs and OB's measure kidney dilation different than urologists do, and often make things seem worse than they actually are. The urologist looked at our ultrasounds and said that Judah's kidney is in the "moderate" range of dilation, and he was not at all worried about function. Then he said magic words. He said, "there is absolutely no reason to deliver them early." As soon as those words came out of his mouth, I immediately felt better. He could tell that we were very worried about it, because of the sighs of relief we both gave after that phrase was spoken. He actually seemed a little upset that delivering them early was even mentioned to us by the other doctor.
So here is where we are now:
After the twins are born, Judah will have an ultrasound of his kidney, to see if the dilation is still present. If the dilation is still present, he will be sent home (yay!) on antibiotics, and will come back in a month or so to do a more invasive test called a VCUG where they insert die into the bladder and ureter to see if there is in fact an obstruction, and to see the severity. If there is an obstruction present that makes the function of the kidney < 30-40%, then little Judah will require surgery to fix the issue. They will do a surgery called Pyeloplasty. They will not do this surgery at least until Judah is 2 months old. This is much better than doing it immediately after he is born. By 2 months, he will be bigger, his lungs will be well-developed and breastfeeding will be well established. Of course I do not wish that he will have to have surgery, but I am much more at peace with this option than with doing the surgery immediately after birth.
I know that this has been a forever long post, and most of it is just me rambling. Sorry. Had to get it out. We didn't really tell a whole lot of people before now because I didn't want to blow anything out of proportion. But it's all good! I'm so relieved that we can now just relax and enjoy the rest of the pregnancy, while preparing and getting excited to meet our little boys!