Aim: Fetal urinary tract dilation (UTD) abnormalities affect 1–5% of all pregnancies. The new UTD classification system was introduced in the year 2014 in order to have uniformity in its diagnosis and management. The present study aims to investigate the clinical utility of the new UTD classification system in antenatal prediction/prognostication of severity. Materials and methods: We conducted a single-center audit of 66 consecutive patients (Jan–Dec 2021) with antenatally diagnosed UTD delivered in our hospital and managed in our pediatric unit postnatally. Ultrasound evaluation of the fetal renal system, both antenatal and postnatal were observed, and UTD-A and UTD-P classification were applied prospectively and retrospectively in all cases as per criteria defined in the new UTD classification. Postnatal outcomes in all cases were evaluated in terms of the need for immediate postnatal surgical intervention and the presence of persistent UTD pathology. Results: There were 51 fetuses in the UTD A1 risk group (Group A) and 15 fetuses in the UTD A2–3 risk group (Group B). Among the groups 10/51 (20%) in UTD A1 group had persistent abnormality [vesicoureteric reflux (VUR) n = 2, non-obstructive dilation (NOD) n = 8] while 12/15 (80%) in UTD A2–3 group had persistent abnormality [pelviureteric junction obstruction (UPJO) n = 1, (NOD) n = 4, (VUR) n = 3, megalourethra n = 1, posterior urethral valve (PUV) n = 3] and this difference was statistically significant (p = 0.001). Among UTD A1, 1/51 (2%) needed surgical intervention [(VUR) with urinary tract infection, n = 1], while in UTD A2–3 group 5/15 (33%) [(UPJO) n = 1, megalourethra n = 1, posterior urethral valve (PUV) n = 3] needed surgical intervention (p = 0.001). Conclusion and clinical significance: We found an increased frequency of complications and surgical interventions in infants with antenatal UTD A2–3 grades in the last prenatal scan in comparison with those with UTD A1 grades. The present study reiterates the usefulness of UTD classification.