Maternal-Fetal Treatments -Case Presentation

Tanya agreed to postpone further diagnostic procedures and over the next week her cramping and bleeding symptoms diminished. Three months later, in her twenty-second week, a second ultrasound is performed. It reveals that her fetus has an abnormally enlarged skull consistent with hydrocephalus. Hydrocephalus is a condition in which the cerebrospinal fluid (CSF) accumulates within the brain’s ventricles, creating pressure on the brain. Hydrocephalus can be progressive, causing the fetal skull to grow excessively large, posing a potential risk to the fetus, brain damage and loss of mental and physical abilities, and to the mother of increased risk of bleeding. Occasionally, however, the situation corrects itself.

Intrauterine treatment, once offered for the progressive form of hydrocephalus, has had disastrous outcomes and has subsequently been abandoned. The protocol now involves delivering the infant by C-section and, once the infant has attained an acceptable body weight, surgically placing a shunt to reduce the CSF. Your hospital has experience performing this procedure with generally positive results.

After Dr. Gomez discusses this with Tanya and Tyrone, she suggests waiting and monitoring the rate of fetal skull development. The rate of fetal skull development may show that the situation has improved spontaneously or give information about whether a C-section should be performed prematurely.

Tanya fears that she will “have a nervous breakdown” if she has to wait to have her baby delivered full-term to find out if it is normal. She insists that Dr. Gomez perform a C-section immediately and if necessary, treat her baby as soon as possible. Dr. Gomez explains that this option will place her infant’s health in jeopardy and offers safe alternatives to assist Tanya with her understandable anxiety. Tanya is not moved and, before long, both she and Tyrone are insisting on an immediate delivery.