Prenatal Counseling

Prenatal counseling is sometimes recommended by a pediatric urologist if it’s known that a child will be born with certain urologic abnormalities. The goal with prenatal counseling is to help parents receive honest, accurate answers to their questions and understand what their available options are when a child is expected to be born with an existing urological problem.

Birth defects, in general, occur in less than 5% of all births in the United States. While this does mean that urologic abnormalities are fairly rare, the news that something out of the ordinary has been discovered during routine prenatal testing or ultrasound screening can cause parents to be apprehensive. For this reason, your doctor may suggest prenatal urologic counseling.

In addition to problems with the urinary tract or kidneys, specific conditions affecting the urinary system that may be reason enough to consider prenatal counseling include:

• Extra fluid in the kidneys (hydronephrosis)
• Abnormally shaped or located tubes that carry the urine (e.g., ureters coming from the kidneys or the urethra that exits the body)
• Abnormal pelvic tissues or structures, including the bladder and vagina
• Abnormal genital organs
• Suspected abnormally functioning kidneys, or only one kidney (renal agenesis)
• Other congenital conditions, such as spina bifida, that may affect the urinary or genital organs

A typical prenatal counseling session involves the expectant parent(s) and a pediatric urologist. Some approaches to this type of counseling may also involve other health care providers. The initial part of the discussion usually starts with a detailed, understandable, explanation of the baby’s potential urologic abnormality.

For instance, if spina bifida was detected during a prenatal ultrasound, parents will likely be advised that their child’s bladder and bowel functions will need to be monitored after birth since this abnormality typically affects pelvic/urologic structures. Prenatal counseling is also a time when parents are encouraged to ask questions and voice their concerns.

Other than putting a baby’s pre-birth condition into perspective, prenatal counseling is often a time when parents can learn what they’ll need to do to properly care for their child after birth.

• In some conditions, like hydronephrosis, where there is extra fluid in the kidney, a pediatric urologist may likely inform parents that the condition will generally resolve on its own as the child grows.
• In other cases, prenatal counseling helps let parents know what to expect from the condition and if there may be possible long term effects from the condition or if the condition will require surgical procedures at some time will likely after birth. Some rare congenital abnormalities like bladder exstrophy, where the bladder is an open plate on the abdominal wall that needs reconstructive surgery following birth often performed in stages, will be explained to the parents prior to birth so that they are informed what may be needed for such a complicated congenital condition.

By being fully aware of possible congenital conditions before birth, parents may have a better idea what to expect once their child is born. In some cases, prenatal counseling may allow the parents to think about possible procedures in advance of birth to be better informed of what is available for treatment after birth.