yes lscs in hydrocephalus

7/31/2019 YES LSCS in Hydrocephalus

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LSCS for Hydrocephalus

YES

Dr Kumkum Mathur

Research Officer, Regional Centre forClinical Research in Human Reproduction,Indian Council of Medical Research

Seth GS Medical College & KEM Hospital


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Women(and their babies)are not dyingbecause of diseases we cannot treat

They are dying because societies have yet

to make the decision that their lives areworth saving

Mahmoud Fathalla - 1997


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Points to Discuss

Changing trends

Safety of LSCS

Evidence in the literature

Skill and training of obstetricians today

Rights of the unborn child

Fetal pain

Regressive belief that India is underdeveloped and SOME babies are dispensable


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Fetal Hydrocephalus

It is an abnormal build up ofcerebrospinal fluid (CSF) in theventricles of the brain

Incidence is 0.3-2.5/ 1000 live births

Also quoted as 1 in 2000 live births

May be isolated or associated withcongenital malformation syndromes


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Hydrocephalus: Management

Early diagnosis is the mainstay

Antenatal monitoring and management

Mild, progressive and severe typesPlanned safe delivery in

consultation with

pediatric surgeonIntensive postnatal care

Medical and surgical

management


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With timely treatment, many children withhydrocephalus go on to lead normal lives


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Fate of the Baby

Hangs in the balance

To live or die ?

What is our duty?Can we justify murder

of a viable fetus

NOThe baby deserves tobe delivered by LSCS


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Not written in stone

Logic dictates thatcertain malformations

that produce sufficientenlargement of fetal

structures are atprobable risk for

dystocia of labor andmay benefit fromabdominal delivery


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Hazards of Vaginal Delivery

Disproportion and its ensuing problems Obstructed labor and rupture uterus

More common with mild degrees ofhydrocephalus which are not detectedantenatally

Maternal injury

Fetal injury

Cephalocentesis

Destructive operations


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LSCS : the preferred choice in

hydrocephalusLSCS is the preferred choiceLSCS is very safeLSCS is a planned, certain, safe optionNo trauma to mother or babyLess contamination hence less postnatal

sepsisSensitive Humane approachNo medicolegal issues


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Why LSCS ?

No compression of head, therefore nocompression of brain

Delivery of baby in controlled manner

No maternal injury by difficult vaginaldelivery of large fetal head

No need to resort to last minute panic and

cephalocentesis Elimination of exposure to and contamination

by vaginal flora (important for postnatalshunt)


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Destructive operations

To be condemned

Only have a place in

books, history andarchives

No place for

mutilating insensitivepractices in modernobstetrics


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Besides their distasteful messiness, themain argument against these operationsis that, in inexperienced hands, they areliable to be even more dangerous thanCesarean section


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Intrapartum cephalocentesis Akin to destructive

surgery

Fraught with dangers

Associated with highfetal morbidity andmortality

Medicolegal and informedconsent issues

Cannot be recommendedfor fetus with a

favorable prognosis


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Evidence from literature No recent studies from the developed world

All studies are retrospective

Normal developmental outcome with treatment

Hydro

cephalustype

Combined ChiariII

AqueductalStenosis

DandyWalker

48% 66% 40% 29%

Chervenak FA Am J Obstet Gynevol 1985


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Evidence from literature

Williams Textbook of Obstetrics 2 studies Mentioned

Recommends abdominal delivery

Am J Obstet Gynecol. 1985 Apr 1;151(7):933-42. The management of fetalhydrocephalus. Chervenak FA, Berkowitz RL, Tortora M, Hobbins JC.Large series of 53 consecutive documented cases of fetalhydrocephalus

Am J Obstet Gynecol. 2001 Sep;185(3):734-6. The role of cephalocentesis

in modern obstetrics. Chasen ST, Chervenak FA, McCullough LB.

Recommendation : cepalocentesis use be limited to fetuseswith severe associated anomalies ,which they concede is

not always possible; all others to be delivered abdominally
http://www.hydroassoc.org/http://www.ncbi.nlm.nih.gov/pubmed/3885737http://www.ncbi.nlm.nih.gov/pubmed?term=%22Chervenak%20FA%22[Author]http://www.ncbi.nlm.nih.gov/pubmed?term=%22Berkowitz%20RL%22[Author]http://www.ncbi.nlm.nih.gov/pubmed?term=%22Tortora%20M%22[Author]http://www.ncbi.nlm.nih.gov/pubmed?term=%22Hobbins%20JC%22[Author]http://www.hydroassoc.org/http://www.ncbi.nlm.nih.gov/pubmed?term=%22Chasen%20ST%22[Author]http://www.ncbi.nlm.nih.gov/pubmed?term=%22Chervenak%20FA%22[Author]http://www.ncbi.nlm.nih.gov/pubmed?term=%22McCullough%20LB%22[Author]http://www.hydroassoc.org/http://www.hydroassoc.org/http://www.ncbi.nlm.nih.gov/pubmed?term=%22McCullough%20LB%22[Author]http://www.ncbi.nlm.nih.gov/pubmed?term=%22Chervenak%20FA%22[Author]http://www.ncbi.nlm.nih.gov/pubmed?term=%22Chasen%20ST%22[Author]http://www.hydroassoc.org/http://www.ncbi.nlm.nih.gov/pubmed?term=%22Hobbins%20JC%22[Author]http://www.ncbi.nlm.nih.gov/pubmed?term=%22Tortora%20M%22[Author]http://www.ncbi.nlm.nih.gov/pubmed?term=%22Berkowitz%20RL%22[Author]http://www.ncbi.nlm.nih.gov/pubmed?term=%22Chervenak%20FA%22[Author]http://www.ncbi.nlm.nih.gov/pubmed/3885737http://www.hydroassoc.org/http://www.hydroassoc.org/


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Indian Data

Arch Gynecol Obstet. 2011 May;283(5):929-33. Epub 2010 Dec 31.

Destructive operations--a vanishing art in modern obstetrics: 25 yearexperience at a tertiary care center in India.

Sikka P, Chopra S, Kalpdev A, Jain V, Dhaliwal L.

Dept of Gynaecology and Obstetrics, PGIMER, Chandigarh 160012, India.

In 85,952 deliveries over 25 years The total numberof destructive operations performed was 230 (0.26%).

Advise individualized approach to each case ofobstructed labor. Choose from available options todeliver the mother by the safest route withoutcausing morbidity and mortality.
http://www.hydroassoc.org/


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The numbers game Incidence of hydrocephalus

0.05% of all pregnancies Incidence of cephalocentesis

Decreased dramatically Number of cases performed in recent

literature Very very few

Most obstetricians will see less than 1 case

per year Stick to the tried and true rather than

struggling with something you are not familiarwith


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Cry of terror

Did anyone ask thisbaby if he or shechose to die ?

"There is no foot so small that itcannot leave an imprint

on this world"


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Rights of the unborn & newbornRight to lifeDo not inflict pain

Give benefit of advances in medicine

especially pediatric surgery to this babyALSO

L C f H d h l


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LSCS for Hydrocephalus

YES

YES YES


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Points Discussed

Changing trends

Safety of LSCS

Evidence in the literature

Skill and training of obstetricians today

Rights of the unborn child

Fetal pain

Regressive belief that India is underdeveloped and SOME babies are dispensable


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destruction


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Success stories.

http://www.hydroassoc.org

http://www.hydrowoman.com
http://www.hydroassoc.org/http://www.hydrowoman.com/http://www.hydrowoman.com/http://www.hydroassoc.org/


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yes lscs in hydrocephalus

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