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Re: Cephalocentesis-question From: Steve & Eryl Raymond (eryl@intekom.co.za) Tue May 23 08:28:32 2000 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: DoctorJoe@aol.com: "Fwd: California Pacific Medical Center Study Finds..." Previous message: art fougner, md: "Re: OB: Billing...now phone Rx." In reply to: Dr.Mohamed Saeed: "Cephalocentesis-question" Next in thread: Efrain Ramirez: "Re: Cephalocentesis-question" We see this sort of case very regularly and deal with it in exactly the way you have described. There is no question of the responsible person being the obstetrician. First, we don't have a neurosurgeon, and second it doesn't form part of a neurosurgeon's job. The decision to do a head decompression is based on the evidence that the hydorcephaly is not alone. If it were alone we would prefer to deliver the baby by C/S so as to allow the best health possible for later insertion of a shunt. Where the Arnold Chiari malformation is present the prognosis is extrememly poor and no neurosurgeon would even consider a shunt in our area. Cause of death? - any one of a number of things. The malformation itself undoubtedly; the use of a needle to decompress the head; infection of the meninges through the open neural tube defect; septicaemia from pyelonephritis due to the paralysed bladder; respiratory failure due to malformation of the brain-stem - take your pick. As I said, the prognosis is so poor that one can regard the death as inevitable. On 22 May 2000, at 11:05, Dr.Mohamed Saeed wrote: > A 36 yrs. Old lady coming to the casuality with the following > diagnosis: P5+1, 38 weeks-gestation, cephalic, in labour, rheumatic > heart disease (mitral valve regurge with prolapse), fetus was > hydrocephalic (cortical thickness=7mm), with open spina bifida(shown > by real time ultrasound and confirmed post-natally with skin, bony, > and dural loss in a dorsal segment about 4 cm ). > > No antenatal care was done and the mother was coming in labor with > regular uterine contractions 3/10,and 3-4 cm cervical dilatation and > 1.5 cm cervical length. Fetal head was totally abdominal inspite of > good uterine contracions due to the cephalo-pelvic disproportion > caused by the hydrocephalic head. > > An informed consent was taken from the mother (husband was absent) to > perform cephalocentesis to avoid unnecessary cesarean section and this > was done transvaginally by spinal needle through anterior fontanelle > over about 15 minutes, removing adequate amount of the CSF till the > head was able to be engaged. > > About 2 hours later, delivery of the baby occurs giving birth to a > female weighting 2.5kg. No maternal post-partum complications occur > while the baby was admitted to the neonatal ICU. > > CT-Brain was done to the baby on the 4th day revealing corpus callosum > hypoplasia, posterior parietal encephalocele, tight posterior fossa > with scalloping of the petrous pyramids and posterior clival aspect > suggesting Arnold Chiari malformation, and a large posterior parietal > hematoma with layering denoting sedimented blood (acute event) with > transependymal extention. The baby died 6 days after birth. > > Now I want to be answered for the following questions: > 1. Who is the one responsible for doing trans-vaginal > cephalocentesis, the neurosurgent or the obstetrician? 2. Is > cephalocentesis the cause of death? If yes how? And if no what is > (are) the cause(s). Thanks a lot for your kind attention and > reply.Yours Mohamed Saeed Assisstent Lecturer Obstetrics& > Gynecology-Ain Shams University- Maternity Hospital-Cairo E-mail > address: saeedo70@hotmail.com Dr. Steve Raymond Head of Department of O & G Empangeni Hospital Empangeni SOUTH AFRICA 3880 Ph:(+27)(035)77721111 Next message: DoctorJoe@aol.com: "Fwd: California Pacific Medical Center Study Finds..." Previous message: art fougner, md: "Re: OB: Billing...now phone Rx." In reply to: Dr.Mohamed Saeed: "Cephalocentesis-question" Next in thread: Efrain Ramirez: "Re: Cephalocentesis-question"

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