Re: Cephalocentesis-question
From: Efrain Ramirez (eramirez@icepr.com)
Wed May 24 17:51:34 2000
Wow-- did one many, many years ago - residency - baby did not leave LDR
- died.
Neurosurgeon doing things through the vagina? How you dare?
The cause of "death"? Well--
At Mon, 22 May 2000, 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
--
"The things you learn after you know everything are the important ones"
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