Separation of renal pelvis means that the urine of the fetus cannot be discharged normally due to congenital urinary system malformation or dysuria. The swelling of renal pelvis is the symptom of separation of renal pelvis, which can be recovered after the fetus does not urinate or after birth. The renal pelvis is the place where the kidney and ureter connect, and it is also the place where ureter connects. Foreign data show that the incidence of renal pelvis separation in normal pregnant fetuses is 4.5-7%, of which male fetuses account for 60%. Therefore, renal pelvis separation is generally not serious.
Harm of hydronephrosis due to separation of renal pelvis
The collecting system of normal fetal kidney can be slightly separated, and the diameter of separation can reach 6 mm, while hydronephrosis is defined as renal pelvis dilatation ≥ 10 mm or renal calyx dilatation after 30 weeks of pregnancy. Hydronephrosis can be divided into two types.
One is reversible: the width of hydronephrosis is between1.01-1.63 cm, and the renal parenchyma is thicker between 1.02-0.58 cm. After the fetus is born, the environment changes and hydronephrosis disappears. It is common that the fetal bladder is filled with a lot of urine or the ureter contracts irregularly for some reason. In other cases, the ureter may.
The other is irreversible: the width of hydronephrosis is 2. 15-2.56 cm, and the thickness of renal parenchyma is 0.3-0.2 cm. It is common in congenital ureteral stricture, and its secretory function changes a lot, so it should be treated in time after birth.
Urinary system malformation
Congenital urinary system malformation is most common in kidney and ureter, including cystic nephropathy, horseshoe kidney and solitary kidney. Congenital ureteral malformations are common, including complete loss of ureter, such as double ureteral malformation, ureterocele, ectopic ureter orifice, retrocaval ureter, ureter, extrarenal connection, etc. Fetal renal pelvis separation, if greater than 1 cm, may be caused by urinary system malformation.
Physiological renal pelvis separation
Under normal circumstances, when the fetus is urinating, B-ultrasound can also see the separation of renal pelvis; When the fetus excretes urine, the separation of renal pelvis may disappear. Generally speaking, if the separation of renal pelvis is within 10 mm, it is physiological. Don't worry about this situation, just check the B-ultrasound regularly. If the separation of renal pelvis exceeds 65438±0.6mm, further examination is needed to determine whether the fetus has abnormal development of kidney, ureter and other organs.
How to treat the separation of renal pelvis by surgery?
Surgical treatment of hydronephrosis should be carried out as soon as possible. Reasonable application of plastic surgery technology to correct the abnormality of ureteropelvic junction and strive for a greater degree of renal function recovery. After the baby is born, it will be reviewed by color Doppler ultrasound, and whether or not the operation should be decided according to the baby's specific situation. (Pyeloplasty) The purpose of the operation is to correct hunchback, reconstruct urethra, require normal and perfect appearance and solve physiological function problems. Corrective surgery should be completed after 1 year old and before entering school. Although there are many methods, they can be roughly divided into one or two stages.
Knee-chest supine position treatment
After 30 weeks (7 and a half months) of pregnancy
Practice: Kneel with your legs apart and shoulder width apart, and your knees are connected with your chest at a 90-degree angle. Press the chest down, as close to the chest and face as possible, and raise the hips as much as possible. On an empty stomach in the morning and before going to bed, try to keep doing 15-20 minutes each, based on the time you can bear.
With the help of the change of fetal center of gravity and the lateral blocking force of pregnant women, this method increases the chance of fetal turning to head position. Seven days is a course of treatment. If it fails, it can be done for another seven days, with an effective rate of 60%-70%. A few pregnant women will feel dizzy, nauseous and flustered when they are in knee-chest position, and they need to use other methods to correct fetal position.
Note: when the fetus is transposed, it is possible that the umbilical cord may be wrapped around a certain part of the carcass, or even strangled, resulting in fetal hypoxia and abnormal fetal movement. Therefore, it is necessary to review and monitor the fetal heart rate under the guidance of a doctor every week, and record and compare the abnormal fetal movement.
Laser irradiation or moxibustion at Yin Zhi point
Laser irradiation or moxibustion at Yin point (0.3cm near toe corner of little toe), 1 time /d, 15 ~ 20min each time, 1 course of treatment for 5 ~ 7 days.
Note: Persisting in sleeping in the left position is also very helpful for the baby's transposition. If shoulder presentation is found in the third trimester of pregnancy, the correction method is the same as breech presentation. If it fails, try eversion to head position, and abdominal bandage to fix the fetal head. If it fails, the patient should be hospitalized in advance for labor.
Diagnostic criteria for separation of renal pelvis The normal value of separation of renal pelvis is 0 ~ 10 mm, and there is no problem when the fetus is born less than 16mm.
The renal pelvis is only the place where the kidney connects with the ureter. Fetal renal pelvis separation is due to kidney calculi and ureteral malformation, resulting in abnormal urine discharge, so the renal pelvis filling increases. When the fetus holds back urine, renal pelvis separation will also occur. Separation of renal pelvis: = 10mm is severe. However, it is necessary to know whether the fetal bladder is full. If the bladder is full, wait until the fetus urinates. Generally speaking, if the separation of renal pelvis does not exceed 10mm, it belongs to the normal range. There is no problem when the fetus is not more than 16mm at birth. If it continues to increase, it should be reviewed regularly and treatment should be considered. Therefore, the normal value of renal pelvis separation is 0~ 10mm, and there is no problem when the fetus is not greater than 16mm at birth.
Health Tips Many pregnant mothers are worried about whether the child can stay when they find that the fetus has a separated renal pelvis during pregnancy. In fact, there are many factors that cause fetal renal pelvis separation, such as congenital ureteral malformation, kidney calculi, fetal urination and so on. Generally speaking, if the separation of renal pelvis does not exceed 10mm, it belongs to the normal range. There is no problem when the fetus is not more than 16mm at birth. If it continues to increase, it is necessary to review it regularly and consider treatment. Among them, hydronephrosis is the worst result of renal pelvis separation, and the surgical cure rate is very high. Some don't need treatment at all. It's good that children are born with bubbles. Therefore, the separation of renal pelvis is not serious, and pregnant mothers need not worry too much.