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Re: Cephalocentesis-questionFrom: Dr.Mohamed Saeed (saeedo70@hotmail.com)Mon May 29 17:40:41 2000
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 Now let's go to the final step: The reason for which I asked those two silly questions. I was critisized by the father of this died child for being the responsible for her death because of the procedure I'd done (Cephalocentesis). Unfortunately, -if you could imagine- the source of such opinion and such ideas behind my silly questions was the neonatologist let me repeate the neonatologist how told the father such things So now every one AM I GUILTY EVEN IN THE PRESENCE OF JUST INFORMED CONSENT? Finally, I apologize for you all because I was asking such silly questions.
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