Expanding Prenatal Care for Hydronephrosis and Urologic Conditions
Expecting a baby is a joyous time. But when a fetus is diagnosed with a urologic condition, that excitement can quickly transform into fear and worry.
To relieve that anxiety—and enhance care for the baby—the Division of Urology has long offered prenatal consultations to mothers seen through the Fetal-Maternal Center at Children’s Hospital Los Angeles. Recently, the team has been taking advantage of telehealth to offer those visits to more families in California.
“It’s so important for these families to meet with their pediatric urologist before their baby is born,” says Roger De Filippo, MD, Chief of the Division of Urology. “Many hospitals don’t offer these consultations, but they can go a long way in alleviating anxiety and ensuring the best care for the baby.”
Calming fears and planning care
Previously, the in-person consultations took place only with patients of USC perinatologists, through the Fetal-Maternal Center. But in spring 2020, at the start of the COVID-19 pandemic, the team began offering a telehealth option for parents who did not want to visit the hospital in person.
At the same time, telehealth offered the opportunity to expand the visits to patients of community perinatologists throughout Los Angeles—from Long Beach to Thousand Oaks.
Before each virtual visit, the referring perinatologist sends the patient’s records and still images of the latest ultrasounds to the Urology team—which includes Dr. De Filippo; Evalynn Vasquez, MD, MBA; S. Scott Sparks, MD; and Joan Ko, MD. The urologist then meets with the family via video to discuss the diagnosis, answer questions and create a detailed plan of care. A nurse care coordinator from the Fetal-Maternal Center is also part of the visit to ensure the plan is executed and to assist with follow-up appointments.
One of the most common diagnoses the team sees is fetal hydronephrosis, or kidney swelling, which occurs when urine backs up into one or both of the kidneys. In most cases, the condition is mild and does not impact the baby. In more severe cases, surgery may be needed after birth.
“Most of the time, we’re able to deliver good news to parents, which is very reassuring for them,” Dr. Vasquez says. “In more serious cases, the visits help prepare families for what to expect when the baby is born.”
The team also ensures that the baby will receive the appropriate neonatal care. “In some cases, babies are referred to us after multiple hospitalizations and urinary tract infections, which could have been avoided with earlier diagnosis and treatment,” she explains. “The prenatal visits help us create the best plan of care, right from the beginning.”
Other prenatal urologic conditions the team sees include solitary kidneys, duplex kidneys, ectopic kidneys, posterior urethral valves, ureteroceles, genital abnormalities and bladder exstrophy.
Assessing the impact
Dr. Vasquez is leading a clinical study to assess the impact of the consultations—both in-person and virtual—on expectant mothers’ anxiety levels.
Working with her closely on that study are Clinical Research Coordinator Zoë Baker, PhD, MPH, and the division’s second-year fellow, Arthi Hannallah, MD.
“We’ve received tremendous positive feedback from parents after these appointments, but we want to measure that impact in a scientific way,” Dr. Vasquez says. “The goal is to continue to improve our care and expand it to more families.”
