Prenatal intervention helps baby beat the odds

August 23, 2016 | by Edward-Elmhurst Health

Many parents-to-be are eager to learn their baby's gender at the 20-week ultrasound. Some even find creative ways to announce the news to family and friends at either a pink- or blue-themed party.

For Kari and Jacob Rothmeyer of Bolingbrook, the 20-week ultrasound, on Feb. 3, 2016, had a much more serious focus. The image showed their tiny son, to be named Asher, had a severely swollen bladder and very little amniotic fluid. The diagnosis: a urinary tract obstruction caused by posterior urethral valves (PUV). This serious abnormality in the urethra occurs in about 1 in 5,000 births of males and often causes permanent kidney damage.

Obstetrician Kathryn Kemnetz, M.D., of DuPage Medical Group (DMG) Obstetrics and Gynecology, referred the Rothmeyers to high-risk pregnancy specialist Donald Taylor, D.O., also a member of DMG and medical director of the Maternal Fetal Medicine Clinic at Edward Hospital.

"If the amniotic fluid level is normal we watch and wait, but this baby's fluid levels were dropping,” says Dr. Taylor. “This affects urine production and puts lung development at risk. The first step in these cases is to get a urine sample to determine if the kidneys are working. If they're not, not a lot can be done."

To draw the sample, Dr. Taylor inserted a needle through Rothmeyer's abdomen and then through her uterus, ultimately targeting the baby's bladder.

"Fortunately, the test showed the kidney function was sufficient for us to go ahead (with treatment),” says Dr. Taylor. “Without intervention, the mortality rate is about 95 percent. But in this case, the problem had been caught early enough."

Initial treatment involves insertion of a shunt through the mother into the baby's bladder. The shunt is a catheter that creates a pathway for the urine to drain into the amniotic sac as it would normally. Dr. Taylor performed four of these shunt insertions between weeks 20 and week 29. Exact placement of the shunts is challenging and not without risk.

Says Dr. Taylor, "As you're positioning the shunt you could cause bleeding by hitting the umbilical cord or a blood vessel in the placenta. And frequently the shunt becomes displaced."

Baby Asher even helped place the shunt correctly at one point by giving it a good kick.

"He had limited access to toys so I guess he thought he'd try this one," says Dr. Taylor.

On April 1 at Edward Hospital, Dr. Taylor assisted Julie Jensen, M.D., of DMG Obstetrics and Gynecology, in delivering Asher, who was 11 weeks premature. Also on hand were neonatologists, a pediatric nephrologist and a pediatric urologist.

"Asher came out crying and better than we had ever imagined,” says mom Kari. “He stayed in the neonatal intensive care unit for 11 weeks, but only needed a feeding tube for a couple of weeks after he got home."

When Asher was about one month old, Craig Smith, M.D., a pediatric urologist with DMG, performed surgery to open Asher's urethral valve. His urination is now normal.

Like many children who had PUV, Asher may need a kidney transplant when he's a little older, but Kari says his regular tests for kidney function are "nothing too serious at this point."

"Asher's name means 'blessing' and 'son of Jacob,' she says. “And we were so blessed that Dr. Kemnetz introduced us to Dr. Taylor. It also helps that Asher is a fighter. His grandfather even gave him tiny blue boxing gloves and calls him Asher Rocky Rothmeyer."

Learn more about Edward-Elmhurst Health’s pregnancy and baby services and care for high-risk pregnancies.

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