G2P1L1 36 wks gestation (first FTND), admitted with leaking since 5 hrs. 3 cm dilation. Antenatally diagnosed with Hydrocephalus with Spina bifida + meningomyelocele. BPD is 11.2 cm. What should be the best modality of delivery?
to preserve the placode (neural function) and to avoid obstetric thrauma
Cephalocentesis and allow for vaginal delivery. Neuro debt will be poor.
It looks like severe hydrocephalus (based on BPD 11.2 cm). Pediatric surgery reference was done who opined of very poor prognosis. As she was in labor, usg was not feasible, also when only residents were to perform USG. VHR most probably is severe. With poor prognosis with hydrocephalus and meningomyelocele, Is vaginal delivery advisable after performing craniocentesis with epidural needle.
Assess the pros and cons for either mode of delivery and discuss it with the couple. If there is anyy chance of the child surviving, coupled with the cumbersome mechanism of labour which risks injries to the mother, then I would think a caeserean section would be best
What are the guidelines in today's obstetrics practice. How to justify cesarean section in resource poor countries where even normal child does not survive less than 30 weeks of gestation in a Quaternary medical center in Mumbai. Can we become God and do craniocentesis. I have not come across any Guidelines. USG report said Gross Hydrocephalus. I will let you know what I did with this patient and what I have been doing till now. But I am not comfortable.
Some authors associate vaginal delivery to increase of the neurological deficit and trauma to the exposed nervous system. Besides there is also hydrocephalus. In our Institution CS is recommended.
- Badges
- Science topic