Hello XXXXXXX
Thanks for your query.

Hemivertebra is an uncommon congenital anomaly of the spine in which only one half of the vertebral body develops. The incidence of hemivertebra is estimated at 5‑ 10:10,000 births .

Hemivertebrae may be isolated or may occur in multiple areas within the spine and is frequently associated with other congenital anomalies. Hemivertebra is commonly associated with other musculoskeletal anomalies including those of the spine, ribs, and limbs. Cardiac and genitourinary tract anomalies are the more common extra‑musculoskeletal anomalies seen with hemivertebra, with anomalies of the central nervous system and gastrointestinal tract also being reported. Hemivertebra may be part of a syndrome including Jarcho‑Levin, Klippel‑Fiel, and VACTERL. The incidence of karyotypic abnormalities in fetuses with isolated vertebral anomalies is thought to be small.

The prognosis is directly related to the presence or absence of associated anomalies. The prognosis of isolated hemivertebra is good. Left untreated, 25% of patients with congenital scoliosis show no progression, 50% progress slowly, and 25% progress rapidly during growth. Spinal fusion is the treatment of choice for cases of congenital scoliosis. The treatment of congenital scoliosis should occur before significant deformity occurs.

When the prenatal diagnosis of hemivertebrae is made, a meticulous search for associated anomalies should be performed. Chromosomal analysis can be offered, especially in the presence of associated anomalies. Amniotic fluid alpha‑fetoprotein concentration can be assessed if there is a question of an open neural tube defect and the patient is of appropriate gestational age. Serial ultrasonic evaluation is recommended to follow fetal growth and evaluate for signs of an open neural tube defect that may not be present at an initial early ultrasound.

If there are no other complicating factors, standard management of labor and delivery is recommended. A careful neonatal assessment for associated cardiac and genitourinary anomalies needs to be performed and the infant should receive long term orthopedic follow‑up so treatment can occur, if necessary, prior to the development of serious deformity.

Regarding dilated renal pelvis, if it is non progressive, it can be surgically treated after birth.

Presence of 2 anomalies raises the risk of some chromosomal abnormality in the baby.
I would ask you to go for the quadruple marker test and also for amniocentesis, particularly at your advanced maternal age.

Please consult a Genetic Counsellor at the earliest for the needful.
Take care, and feel free to discuss further.

---

Please go for quadruple marker and amniocentesis as advised.

---