Cephalocentesis with the modified Smellie's perforator.
A 37-year-old pregnant woman, gravida 2, para 0, was referred to Ramathibodi Hospital at 31 weeks of gestation with the diagnosis of hydrocephalus and polyhydramnios. Repeated ultrasound scans revealed hydrocephalus with macrocephaly (BPD=10.3 cm), polyhydramnios (AFI=31.5), and a suspected esophageal atresia. After counseling, both parents decided not to pursue the pregnancy and requested vaginal delivery. They decided against transabdominal, ultrasonic-guided cephalocentesis because of its invasiveness, patient's awareness, and pain. Skull decompression with the modified Smellie's perforator was performed after five 400-microg doses of misoprostol were applied to dilate the cervix. The post-partum condition was uneventful. Fetal skull decompression with the modified Smellie's perforator and misoprostol for cervix dilation is a useful, simple, and safe procedure that can be performed with no previous experience.
Chanrachakul
B
B
Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynecology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Chittachareon
A
A
Herabutya
Y
Y
D000015:Abnormalities, Multiple / Q000000981:diagnostic imaging*; D000020:Abortifacient Agents, Nonsteroidal / Q000627:therapeutic use; D000028:Abortion, Induced; D000328:Adult; D005113:Extraction, Obstetrical / Q000295:instrumentation*; D005260:Female; D005315:Fetal Diseases / Q000000981:diagnostic imaging*; D006801:Humans; D006849:Hydrocephalus / Q000000981:diagnostic imaging; D016595:Misoprostol / Q000627:therapeutic use; D006831:Polyhydramnios / Q000000981:diagnostic imaging; D011247:Pregnancy; D011263:Pregnancy Trimester, Third; D012886:Skull; D013525:Surgical Instruments; D016216:Ultrasonography, Prenatal
D000020:Abortifacient Agents, Nonsteroidal; D016595:Misoprostol