loren, complications such as?

Research on Diagnosis of congenital hydrocephalus and delivery of its patients in Japan showed that the adoption ratio of cesarean delivery to transvaginal delivery was around 7 to 3 in patients with fetal hydrocephalus, and 2 to 7 in patients with infantile hydrocephalus, respectively, with significant difference between fetal hydrocephalus and infantile hydrocephalus groups (p < 0.001). Clinical outcomes in patients with fetal hydrocephalus was better in those delivered transvaginally than in those by cesarean delivery, although without no statistical significance (p = 0.124) and those in patients with infantile hydrocephalus showed almost no difference between transvaginal and cesarean delivery groups.

Moritake. 2007. Diagnosis of congenital hydrocephalus and delivery of its patients in Japan. Available at: http://www.journals.elsevierhealth.com/periodicals/bradev/article/PIIS0387760407002458/abstract

The adoption ratio of cesarean delivery to transvaginal delivery was around 7 to 3 in patients with fetal hydrocephalus, and 2 to 7 in patients with infantile hydrocephalus, respectively, with significant difference between fetal hydrocephalus and infantile hydrocephalus groups. Clinical outcomes in patients with fetal hydrocephalus was better in those delivered transvaginally than in those by cesarean delivery, although without no statistical significance.

Kouzo Moritake, Hidemasa Nagai, Noriko Nagasako, Mami Yamasaki, Shizuo Oi and Toshiyuki Hata. (2007). Diagnosis of congenital hydrocephalus and delivery of its patients in Japan.

yes I agree with ms thea. The method of delivery that is applicable is cesarean section because there are alot of complications may arise if the baby will be delivered via NSD.

for ara, what do those researches your referring to suggest? Why is CS, accdg to those researches do not provide the best outcome for this case?

The method of delivery can affect the outcome for fetuses with this condition. Since the characteristics of the condition as reflected in the case is the build up of CSF in the ventricles in the brain that contributes to rising ICP, labor and vaginal birth can exert pressure on the damage tissues, which can exacerbate the condition. This implies that the mode of delivery preferred would be the Caesarean SEction...

However, some researches suggests that CS is not the optimal route of delivery for fetus with myelomeningocele..

amazing! thank you for your best guesses ara and thea. as they say it. the problem could be classified under chiari malformations:



Chiari II abnormality

-which is associated with meningomyelocele, anencephaly, and encephalocele, all of which belong to a group of disorders known as neural tube defects. These serious congenital anomalies of the nervous system, which occur during the 1st 4 weeks of gestation, result from faulty formation of the neural tube.

- the cerebellum been pushed downward into the spinal canal, but so has the fourth ventricle and the medulla (lower portion of the brainstem). This type is generally associated with spina bifida (myelomeningocele)

we've learned something new today.. let's move on with the second question.

thank you angel, raiza, jenny and loren for those inputs.

so while you are still thinking for the answer to my follow up question, thi is the summary for no.,1 question, the possible diagnostic tests are the following:

- ultrasound
-fetal MRI

Ultrafast fetal MRI is a more anatomically precise modality for prenatal neuroimaging.

-CT scan
-amniocentesis
- AFP

I agree with ara, i have also read that Chiari malformations happen when the indented bony space at the lower rear of the skull, known as the posterior fossa, is smaller than normal, the cerebellum and brainstem can be pushed downward. The resulting pressure on the cerebellum can block the flow of cerebrospinal fluid causing hydrocephalus.

Chiari II - In this type not only has the cerebellum been pushed downward into the spinal canal, but so has the fourth ventricle and the medulla (lower portion of the brainstem). This type is generally associated with spina bifida (myelomeningocele) which is a condition where the spinal cord does not close properly before birth.

Department of Neuroradiology, St. Chiara Hospital, Via Roma, 67, I-56100 Pisa, Italy e-mail: rcanapicchi@inpe.unipi.it

Hydrocephalus can be defined broadly as a disturbance of formation, flow, or absorption of cerebrospinal fluid (CSF) that leads to an increase in volume occupied by this fluid in the central nervous system (CNS). This condition also could be termed a hydrodynamic disorder of CSF. Acute hydrocephalus occurs over days, subacute over weeks, and chronic over months or years. Conditions such as cerebral atrophy and focal destructive lesions also lead to an abnormal increase of CSF in CNS. In these situations, loss of cerebral tissue leaves a vacant space that is filled passively with CSF. Such conditions are not the result of a hydrodynamic disorder and therefore are not classified as hydrocephalus. An older misnomer used to describe these conditions was hydrocephalus ex vacuo.

Hydrocephalus is diagnosed through clinical neurological evaluation and by using cranial imaging techniques such as ultrasonography, computed tomography (CT), magnetic resonance imaging (MRI), or pressure-monitoring techniques. A physician selects the appropriate diagnostic tool based on an individual's age, clinical presentation, and the presence of known or suspected abnormalities of the brain or spinal cord.





hydrocephalus
Author: Eugenia-Daniela Hord, MD, Instructor, Departments of Anesthesia and Neurology, Massachusetts General Hospital Pain Center, Harvard Medical School
Contributor Information and Disclosures

according to the literature.. it can be a case of Chiari II abnormality which is associated with meningomyelocele, anencephaly, and encephalocele, all of which belong to a group of disorders known as neural tube defects. These serious congenital anomalies of the nervous system, which occur during the 1st 4 weeks of gestation, result
from faulty formation of the neural tube.

For diagnosis of fetal hydrocephalus, either US or MRI had become dominantly utilized and CT had gone out of use in 1996–2000.

Diagnosis of congenital hydrocephalus and delivery of its patients in Japan
Kouzo Moritake, Hidemasa Nagai, Noriko Nagasako, Mami Yamasaki, Shizuo Oi and Toshiyuki Hata. (2007).

During pregnancy, routine ultrasound can detect enlarged ventricles (spaces) within the baby’s brain. (Source: http://www.hydroassoc.org/education_support/learning/diagnosis)

Diagnostic Ultrasonography is the most commonly used method for examining pregnant women and tracking fetal development because it allows real time xamination of the fetus while avoiding radation.

thank you for the input thea and ara. i have a follow-up question, since we are talking about diganostic tests and we've mentioned ultrasound and amniocentesis where amniocentesis detects chromosomal defects, thea mentioned trisomy 21 and 18, with your best guess, what could be the possible underlying problem of this infant?

Hydrocephalus may be diagnosed on a routine ultrasound. The ventricles within the head will measure larger than normal. The head circumference may remain within the normal limits or it may become enlarged as the pregnancy progresses.

Hydrocephalus is also occasionally associated with chromosomal abnormalities. 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. The perinatologist typically will offer an amniocentesis to look for chromosomal issues.

Another test that may be recommended is a fetal MRI. Ultrasound imaging can be limited by the mother's body habitus, the surrounding amniotic fluid and the position of the fetus. Fetal MRI is a non-invasive diagnostic test that produces better images of soft tissue, and bone or dense tissue does not interfere with the image. The biggest limitation of fetal MRI is that the best images are obtained when the fetus stays still.

Seppala and Unnerus (1974) postulated that the increase in amniotic fluid alpha-fetoprotein levels that they observed in four cases of fetal hydrocephalus might be due to passage of AFP-containing cerebral spinal fluid across the greatly thinned fetal skull into the amniotic cavity. In such cases, excess AFP in the amniotic fluid might pass into the maternal serum by diffusion across the placenta and fetal membranes. However, none of their patients had elevated MSAFP levels and at least one other report failed to document even an elevation of AFAFP.


Szajkowski .2006. Maternal serum alpha-fetoprotein levels in fetal hydrocephalus: a retrospective population based study. Available at: http://www.biomedcentral.com/1471-2393/6/23


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