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Your Pregnancy After 35 : How Your Baby Grows and Develops (part 5) - Hydrocephalus, Cordocentesis, Fetal Surgery

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13. Hydrocephalus

Hydrocephalus causes an enlargement of the fetus’s head. It occurs in about 1 in 2000 babies and is responsible for about 12% of all severe fetal malformations found at birth.

The organization and development of the baby’s brain and central nervous system begin early. Cerebral spinal fluid circulates around the brain and spinal cord; fluid must be able to flow without restriction. If openings are blocked and flow is restricted, it can cause hydrocephalus (sometimes called water on the brain). Fluid accumulates, and the baby’s head becomes enlarged.

Hydrocephalus is only a symptom, and it can have several causes. Once hydrocephalus is diagnosed, a cause is sought; these include spina bifida, meningomyelocele and omphalocele. Sometimes intrauterine therapy—therapy performed while the fetus is still in the uterus—is possible. See the discussion in the following section.

14. Prenatal Treatment of the Fetus

In this discussion, “prenatal treatment” refers to treatment of the baby, not treatment of a pregnant woman. Treatment of a fetus in utero has proved to be a valuable tool in saving the lives of some babies.

15. Cordocentesis

The earliest form of in-utero treatment involved blood transfusions to fetuses with a life-threatening form of anemia. We now have more refined blood-transfusion techniques. Cordocentesis is a transfusion procedure by which blood is introduced directly into the fetal bloodstream through the umbilical cord.

The greatest use of medication in utero is to hasten development of fetal lungs. If you’re at high risk for a preterm birth, your healthcare provider may recommend this treatment to ensure that your baby’s lungs are adequately developed before birth. If a baby is born before its lungs are mature, it can develop respiratory-distress syndrome.

If your healthcare provider believes you are at risk of delivering your baby before 34 weeks gestation, he or she may prescribe corticosteroid injections. This medication passes from your bloodstream into the fetus’s bloodstream, reducing the risk of infant death or the risk of complications, such as breathing problems. It appears to be safe for both mother and fetus.

A less common problem that may be treated before birth with medication is a heart-rhythm disturbance. Medication is usually given to the mother to treat her baby. In some cases, healthcare providers deliver medication directly to the fetus via cordocentesis.

Other problems cordocentesis is used for include inherited inborn errors of body chemistry. Treatment with medication given to the mother has been very successful.

16. Fetal Surgery

Fetal surgery can treat various problems while a baby is still growing inside the mother. Open surgery or closed-uterus surgery may be performed.

Most surgeries, whether open or closed-uterus, are not performed until at least 28 weeks of pregnancy. Surgeries treat a variety of problems, including urinary-tract blockages, tumors and fluid in the lungs.

With open surgery, the surgeon makes a Cesareanlike incision in the mother’s abdomen, partially removes the fetus, performs surgery, then returns the fetus to the uterus. Open surgery carries risks for mother and baby. One problem with open surgery is it may stimulate uterine contractions, which can lead to premature birth. The surgery exposes the mother to all the risks of surgery, including anesthesia problems and infections. After open surgery, the mother must have a Cesarean delivery when it is time to deliver the baby.

Closed-uterus procedures are more common than open surgeries. With this surgery, miniature cameras guide a needle-thin fiberoptic instrument into the fetus’s body while the fetus remains inside the uterus. The most successful closed-uterus surgeries are associated with the opening of urinary-tract blockages.

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