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Does my fetus lack the urinary bladder?

Q: I am 6 months pregnant and in my recent scan of the baby, the doctor said that the urinary bladder is missing. The doctor has, however, asked for a second opinion. I have less fluid in my womb and have been asked to drink lots of water. Is it possible that due to the less fluid, the urinary bladder of the baby has got ruptured? Is there any specific kind of scan that can be done to find this out? I am really worried about this now.

A:At the outset I want you to understand that the ultrasound report rarely if ever gives an absolute diagnosis and the report is nearly always very subjective. You should not be worrying until a clear diagnosis is made on the cause of the decreased liquor. Anyway what is important is how much fluid is there in the uterus (if any)? If there is no fluid at all, it is serious and it generally means that the fetal kidneys are not present or not working. But if it only a little less, it really is an impression and not as worrisome...and is open to interpretation. Once the fluid is less the ultrasound picture is not very clear and therefore even more difficult to interpret. So one does not know how reliable the absent urine bag report is. The main source of water around the baby in the uterus is fetal urine. There are only few ways you will have no fluid around the baby at all, one is that the kidneys are absent (as a congenital defect) or not working at all. Or the bag around the baby has ruptured without you realising and the water has drained, which you thought was urine. Either way, the prognosis is not good and you need to see a specialist. You need a detailed ultrasound by a qualified and experienced sonologist (but no special kind of ultrasound) but more importantly you need a good clinician/obstetrician who has experience in handling such cases. If you are in a metropolitan city you may be able to consult a fetal medicine specialist who will do all the required counselling, ultrasounds and pregnancy care. Unfortunately in many cases the pregnant lady keeps being shunted between an ultrasound specialist and a gynaecologist, when neither wants to commit to a definite diagnosis or management. As far as having more or less water to drink is concerned, it has no bearing at all on the amount of water around the baby. There is no scientific logic in drinking more water to send water to the baby's urinary bag. There is no connection whatsoever, (there is no pipe between your mouth and uterine cavity) so any such advice can be given by a lay person and I refuse to believe that any doctor would have told you that, as it has no scientific basis at all. Anybody who has asked you to drink more water does not know any medicine at all and such opinions should be avoided. A lot of times when the ultrasound specialist is not sure of the diagnosis, as indeed we often are not, in stead of just asking you to take another opinion he/she asks you to get special ultrasound like colour Doppler or 3 D/4D scan. In my opinion it is not right to say so. I would much prefer to if we as doctors would explain to the doctor incharge of the case that the ultrasound has its limitations like all technologies and indeed everything in modern medicine and a second opinion never harms anyone. The limitation is in subjectivity of interpretation and not in the technology. What you need is a normal thorough 2D real time scan (the variety every basic machine has!).

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