Prune-belly syndrome detected by ultrasound in the first trimester and the usefulness of vesicocentesis as a modality of treatment
A 36-year-old woman (gravida 1, para 0) at gestational age of 11+6 weeks was transferred to our hospital for further evaluation of the suspected fetal abdominal cyst. She had been diagnosed with diabetes mellitus 2 years before and had regular insulin injections. Otherwise, she had neither familial nor past medical history. Ultrasonography at our hospital confirmed enlarged fetal bladder with the size of 2.7×2.5 cm () but the classic 'key hole sign' was absent. Other fetal biometric values were appropriate for the gestational age; crown rump length (CRL) 45 mm, neural tube (NT) 0.7 mm.\nChorionic villus sampling resulted in 46, XY karyotype. Based upon informed consent, vesicocentesis with 22-gauge spinal needle was performed under ultrasonographic guidance (Voluson E8, GE Medical Systems Kretztechnik GmbH & Co. OHG, Zipf, Austria). The aspirated fetal urine was analyzed. As fetal bladder was not enlarged again until 1 week after vesicocentesis, the procedure seemed to be effective. However, the pregnancy was interrupted because the patient and her husband changed their mind and strongly requested termination of pregnancy. Postmortem gross examination confirmed prenatal ultrasooographic diagnosis. Besides, undiagnosed anomalies were identified; bilateral cleft lip, cleft palate, bilateral club feet, and polydactyly ().