The dilemma of prenatal hydrocephalus: Grading and classification of fetal hydrocephalus

Abstract

The values of prenatal diagnosis of hydrocephalus have been recognized. In many centers, the regular and frequent fetus examination by ultrasonography is a right for every pregnant lady to have. Prenatal examination is a routine procedure in most obstetric departments. The recent improvement of the methods of investigations such as 3D ultrasonography and MRI has allowed early prenatal diagnosis of several congenital anomalies (Depp et al., Obstet Gynecol 61(6):710-4, 1983; Glick et al., J Pediatr Surg 19(6):870-1, 1984; Glick et al., J Pediatr 105(1):97-105, 1984; Mrozik et al., Geburtshilfe Frauenheilkd 45(8):503-10, 1985; Schott et al., Arch Gynecol Obstet 280(2):293-6, 2009; Ville, Bull Acad Natl Med 192(8):1611-21, 2008), and CNS congenital anomalies are not an exception! Several CNS congenital anomalies are possible to be diagnosed in utero (Awary et al., Pan Arab Neurosurg J 1:31-35, 1997; Birnholz and Frigoletto, N Engl J Med 304(17):1021-3, 1981; Bruner, Semin Fetal Neonatal Med 12(6):471-6, 2007; Dolk et al., Adv Exp Med Biol 686:349-64, 2010; Dukanac Stamenkovic et al., Clin Exp Obstet Gynecol 43(1):63-9, 2016; Frigoletto et al., JAMA 248(19):2496-7, 1982; Ortega et al., BMC Neurol 16:45, 2016; von Koch et al., Childs Nerv Syst 19(7-8):574-86, 2003). The diagnosis of prenatal fetal spina bifida hydrocephalus, IVH, and other congenital anomalies provoked serious questions and challenges to the treating teams usually composed of neurosurgeons, neonatologists, obstetricians, anesthetist, pediatricians, and others. The questions and challenges are What to do?, What are the advantages of early intrauterine intervention?, and What are the possible complications and consequences for both the mother and the fetus? (Davis, Clin Perinatol 30(3):531-9, 2003; Dolk et al., Adv Exp Med Biol 686:349-64, 2010; Holzgreve et al., Childs Nerv Syst 9(7):408-12, 1993; Serlo et al., Childs Nerv Syst 2(2):93-7, 1986). Taking into consideration the safety and well-being of the pregnant mother should always be absolutely observed and never be compromised. There are several options in facing these challenges that have been performed and suggested such as: Abortion Intrauterine intervention, either open or through endoscope Early and preterm induced delivery or performed elective Cesarean section (CS) to deliver the fetus Follow-up and observation.