Introduction: Fetal hydronephrosis is a condition characterized by the dilation of the urinary tract in the fetus, which can have various underlying causes and outcomes. The prevalence of this condition ranges from 1 to 2%, and most cases resolve on their own. The goal of detecting fetal hydronephrosis is to differentiate between physiological and pathological types to provide appropriate treatment and advice. Various grading systems have been used to assess the severity of hydronephrosis, but their diagnostic consistency has been limited. In 2014, a new classification system called the multidisciplinary consensus on the categorization of prenatal and postnatal urinary tract dilation (UTD) classification system was introduced to address these limitations. Objective: This study aimed to use the UTD classification system to categorize antenatal fetal hydronephrosis and evaluate the need for postnatal treatments such as antibiotics or surgery. The study also assessed the use of the UTD system for parental counseling. Materials and methods: The study was conducted at the maternal and fetal medicine center over a 3-year period. Pregnant women with a diagnosis of fetal hydronephrosis before 22 weeks of gestation were included in the study. Fetuses were classified into low-risk (UTD A1) and high-risk (UTD A2) groups based on the UTD system. Postnatal follow-up and treatment were performed according to the UTD classification. Results: Out of 124 cases of fetal hydronephrosis, 80% were classified as low-risk (UTD A1), and 20% were classified as high-risk (UTD A2–3). The low-risk group showed favorable outcomes, with 70% of the fetuses exhibiting no evidence of hydronephrosis postnatally. In contrast, most fetuses in the high-risk group required additional imaging and treatment. The need for antibiotics and surgery increased significantly with higher UTD classification. Discussion: The study results demonstrate that the UTD classification system is correlated with the risk of neonatally verified hydronephrosis, the need for postnatal imaging, and the requirement for active treatment. This classification system allows for better parental counseling and helps in making informed decisions regarding treatment and follow-up. Conclusion: The UTD classification system is a reliable and practical method for assessing fetal hydronephrosis. Fetuses in the low-risk group have favorable outcomes, while those in the high-risk group require closer monitoring and treatment. The UTD system provides valuable information for parental counseling and guides the need for further care after an initial diagnosis. However, the study has limitations due to its small sample size and retrospective design, highlighting the need for larger, multicenter studies to validate these findings.