>and to add, the diagnostic test that will really prove it would be the sonogram/UTZ.

Traditionally, fetal hydrocephalus has been detected prenatally using sonographic measurements of the enlarged ventricles.

A complete ultrasound examination is carried out to search for additional abnormalities. But ultrasound evaluations alone can miss important anomalies, which will affect the outcome.

Ultrafast fetal MRI is a more anatomically precise modality for prenatal neuroimaging.an MRI scan is obtained and interpreted by an experienced pediatric neuroradiologist to rule out any additional CNS anomalies. There is no apparent risk to the mother or fetus from the radiofrequency pulses or the magnetic field.

Amniocentesis it can rule out most chromosomal problems. Some of the conditions that can cause hydrocephalus are caused by chromosomal abnormalities such as Down Syndrome (also known as Trisomy 21) or Trisomy 13 or 18 which are generally fatal.

Fluorescence In Situ Hybridization. Results are faster compared to amniocentesis. These types of defects account for nearly 95% of all chromosomal abnormalities. It's not the full set of results, but it can rule out some of the biggies early in the process.

Reference:

2009 The Children's Hospital of Philadelphia. The Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, Pa. 19104 http://www.chop.edu/consumer/jsp/division/generic.jsp?id=81168

>just like what we have in our face to face discussion, the amniocentesis is both a diagnostic and screening test.. so it will just suggest a possible neural tube defect... thanks Tina for that clarification.

ara and for everyone as well, is amniocentesis specific, like, it will really detect if hydrocephalus is present or detect only the general problem and not go into specifics such as the manifestation, hydrocephalus?

For this case, the possible prenatal diagnostic tests that can be done are:

> Amniocentensis: alpha-fetoprotein in amniotic fluid (by 14 weeks' gestation) suggests open neural tube defects.
>Ultrasound: this readily diagnose the condition (as reflected in the case)
> Fetal MRI: Useful when maternal habitus renders ultrasound studies suboptimal.
Identifies associated anomalies, i.e., cerebral migration disorders,
diastematomyelia, callosal anomalies. (van Zalen-Sprock et al., 1995).

Laboratory Tests Prenatal:
Prenatal:Maternal serum alpha-fetoprotein levels. Elevated alpha-fetoprotein level at 16–18 weeks suggests fetal open neural tube defects, indicating further prenatal evaluation and genetic counseling.

Reference: van Zalen-Sprock RM, van Vugt JM, van Geijn HP. First and early second
trimester diagnosis of anomalies of the central nervous system. J Ultrasound Med 1995;14:603–610. Electronic Version available at Medline.

Hi! Good evening classmates! I'm Tina. I will be the moderator for tonight's discussion.

For the discussion, everyone is free to speak out her mind regarding the topic. Please support your arguments with studies/literature. Please be guided by the rules on our previous meetings.

For tonight, we will be discussing about adolescent pregnancy with congenital malformations and pregnant women at risk for preterm labor.

CASE NO.1

Adolescent pregnancy and congenital malformations

A 16-year-old patient at one suburban obstetric clinic received upsetting news when an ultrasound exam revealed that her fetus had hydrocephalus; an abnormal accumulation of cerebrospinal fluid within the ventricles of the brain. The fluid build-up can raise intracranial pressure and enlarge the head, making normal passage of the fetus through the birth canal impossible. If persistently high, the pressure destroys white matter and cause mental retardation. Serial ultrasounds showed progressive build-up of fluid and moderate head enlargement. In addition, a lumbar meningomyelocele was identified. The gestational age of the fetus is 34 weeks.


Questions:

1. What other diagnostic/s test can the nurse practitioner suggest to detect the abnormalities?
2. What do you think will be the best method of delivery in this case? Justify.
3. What are the possible reactions of the mother to this situation considering her own her growth and development level?
4. How would an understanding of Erik Erikson’s psychosocial theory be applied in this situation?
5. What nursing diagnoses will be relevant during the prenatal, intranatal, and postnatal period? How would you prioritize these nursing diagnoses?