Hydrocephalus and D&X (1 Viewer)

[1069]

Approximately 1 in 2,000 fetuses develop hydrocephalus while in the womb.
Occasionally not discovered until late in the second trimester, it is then not unusual for the fetal head to be as large as 50 centimeters (nearly 20 inches) in diameter, and to contain close to two gallons of cerebrospinal fluid (the average adult skull is about 7 to 8 inches in diameter).

Abortions after the 24th week of pregnancy comprise .08% of all abortions performed in the US. About 15% of these are accomplished via D&X (as opposed to the more common D&E, which accounts for 85% of late term abortions).

Mild to moderate hydrocephalus can be sometimes be treated in utero and the fetus saved, and some very mild cases can be delivered and treated after birth.
Those which have advanced or severe hydrocephalus cannot. In these cases, D&X is required, as the draining of cerebrospinal fluid from the fetus's skull allows the skull to be collapsed to the point that it can be extracted via the birth canal.
Without this draining and collapsing of the fetal skull, patients in this situation would face catastrophic health consequences.
The fetus with severe hydrocephalus cannot live, and there is no valid reason for the patient in this situation to risk death, infertility, permanent disability or mutilation.

Approximately 500 women face this procedure each year. Without it, these births would kill the patient, with no chance of survival for the fetus, either.
While some fringe radicals may find 500 to be an insignificant number- collateral damage in the war against abortion, as it were- there is no court in this country which will not uphold the constitutional right of such patients to receive life-saving treatment under these catastrophic and potentially lethal circumstances, up to and including the highest court in the land.
I understand that many of you do not want to believe it, but you must begin to acclimate yourselves to the idea. The ban on third trimester abortion will not be upheld by the Supreme Court. And tedious, childish, profanity-laced rants about how critically ill patients ought to be forced to "pierce the scissors through the skull her damn self. That way she gets a look at her choice right up freaking close" are counterproductive and only serve to make the anti-choice contingent look more fringy, fanatical, ignorant, and puerile.

 

[talloulou]

Approximately 1 in 2,000 fetuses develop hydrocephalus while in the womb.
Occasionally not discovered until late in the second trimester, it is then not unusual for the fetal head to be as large as 50 centimeters (nearly 20 inches) in diameter, and to contain close to two gallons of cerebrospinal fluid (the average adult skull is about 7 to 8 inches in diameter).

Abortions after the 24th week of pregnancy comprise .08% of all abortions performed in the US. About 15% of these are accomplished via D&X (as opposed to the more common D&E, which accounts for 85% of late term abortions).

Mild to moderate hydrocephalus can be sometimes be treated in utero and the fetus saved, and some very mild cases can be delivered and treated after birth.
Those which have advanced or severe hydrocephalus cannot. In these cases, D&X is required, as the draining of cerebrospinal fluid from the fetus's skull allows the skull to be collapsed to the point that it can be extracted via the birth canal.
Without this draining and collapsing of the fetal skull, patients in this situation would face catastrophic health consequences.
The fetus with severe hydrocephalus cannot live, and there is no valid reason for the patient in this situation to risk death, infertility, permanent disability or mutilation.

Approximately 500 women face this procedure each year. Without it, these births would kill the patient, with no chance of survival for the fetus, either.
While some fringe radicals may find 500 to be an insignificant number- collateral damage in the war against abortion, as it were- there is no court in this country which will not uphold the constitutional right of such patients to receive life-saving treatment under these catastrophic and potentially lethal circumstances, up to and including the highest court in the land.
I understand that many of you do not want to believe it, but you must begin to acclimate yourselves to the idea. The ban on third trimester abortion will not be upheld by the Supreme Court. And tedious, childish, profanity-laced rants about how critically ill patients ought to be forced to "pierce the scissors through the skull her damn self. That way she gets a look at her choice right up freaking close" are counterproductive and only serve to make the anti-choice contingent look more fringy, fanatical, ignorant, and puerile.

So given all that would you be in favor of banning D&X procedures except in cases where it is medically necessary in order to keep the mother from physical danger?

 

[Felicity]

http://www.chop.edu/consumer/jsp/division/generic.jsp?id=81168
Treatment options
A thorough understanding of the natural history of fetal hydrocephalus should form the basis for rational treatment and parental counseling. Unfortunately, understanding of the natural history is presently insufficient to definitively provide an exact prognosis or offer fetal therapy. It is clear that fetal ventriculomegaly with associated abnormalities have a poor outcome. In cases of ventriculomegaly associated with infections, chromosomal abnormalities and severe CNS and extracranial abnormalities, a poor prognosis may lead a family to end the pregnancy.

The outcome of isolated fetal hydrocephalus, however, is variable. It is related to etiology or cause and in all cases, outcomes appear to be less favorable when compared to neonatal counterparts:

Percentage of normal developmental outcome


Combined..........Fetal Hydrocephalus..........Neonatal Hydrocephalus
Chiari II............48%................................50-80%
Aqueductal........66%................................70%
Stenosis.............40%...............................50-65%
Dandy Walker.....29%................................30-50%



These differences in outcome are most likely related to the period of untreated in-utero hydrocephalus, forming the rationale for early intervention. Prenatal factors such as progression, degree of cortical mantle thinning to less than 1.5 cm and in-utero duration of greater than four weeks are associated with a poor prognosis. On the other hand, those with mild isolated ventriculomegaly of less than 12 mm have an excellent prognosis.

Therefore, treatment depends on the type of fetal hydrocephalus, rate of progression, gestational age and, ultimately, the family's wishes. Isolated hydrocephalus without associated malformations, detected before the legal abortion limit, may be reason enough to terminate the pregnancy for families who cannot accept the prospect of having a handicapped child.

Otherwise, the fetus is followed with serial ultrasounds. If the ventriculomegaly is stable, the fetus is carried to term. This does not deny the possibility of ongoing, irreversible damage in stable hydrocephalus, but recognizes that at present, there is no data to mandate preterm intervention. A Cesarean section is performed at the discretion of the obstetrician when head size precludes vaginal delivery .

A small group of fetuses will undergo rapidly progressive ventricular enlargement. While this does not necessarily foretell a devastating outcome, it does appear to be a significant adverse predictor and consideration should be given for early delivery and early shunting.

Morbidity and mortality data related to prematurity argue against delivery and shunting before 32 weeks. Beyond this point, there continues to be a small risk of complications from early delivery including cerebral palsy, intraventricular hemorrhage, necrotizing enterocolitis and respiratory distress syndrome. These risks diminish as gestation progresses to term.

There is also an increased risk of shunt infection from early delivery. The overall shunt infection rate is 3 to 10 percent, but may be as high as 20 percent in preterm infants. A shunt infection can be devastating for the neonate or premature infant, especially when it involves gram-negative organisms. The risk of shunt infection is very real and must be weighed against the largely theoretical benefit of early delivery. With this in mind, early delivery and shunting may be performed after 32 weeks for the rapidly progressive hydrocephalic fetus with documented lung maturity. A Cesarean section is preferred, followed by immediate shunt insertion to eliminate vaginal and ICU flora exposure and colonization.

Fetuses who develop progressive ventricular enlargement and cortical thinning from hydrocephalus before 28 weeks may have irreversible damage by 32 weeks. Fetal shunting may be considered, but only in the context of a clinical trial and in a center with extensive experience in fetal surgery.

For the small percentage, of the small percentage of children with hydrocephaly in utero, there are treatment options. Sucking their brains out would only be "required" by a woman who has "given up" on a "tolerable" outcome (note the portion I bolded that reveals the REAL motive for aborting many of these children) and has decided that she would rather deliver her child vaginally for a variety of reasons--few of which would be medically necessary. Also, in a D&X, the child need not be killed by removing the brain. She could be killed via drugs which have their own ugly reality as well but are less disgusting and barbaric (although still are so) IMHO.

At any rate--These are done NOT for the health of the mother except in BEYOND extraordinary instances. In the medically advanced society in which we live--I can't think of an instance where a D&X would be the "only option."

 

[taxedout]

There is no life saving indication for D&X.
So I am in favor of reserving this procedure only for those cases.