Baby had excess fluid in the head

Handling hydrocephalus in babies in the womb

When Ann came to the hospital at her 38th week of pregnancy together with her husband, she was not aware that she was carrying a hydrocephalus baby in her womb. They had come to book for labour and delivery.

I explained to her our packages and asked her how she was feeling. She gave a history of having attended antenatal care at a clinic near her home area. She felt as if she was due-she was experiencing some abdominal pains. The couple then decided to do a scan, their first.

Since it was their first baby, Ann and her husband looked happy and could hardly wait for the results. However, after the scan, the doctor delivered a devastating report; the foetus had some abnormalities. A specialist was requested to interpret the scan report. The baby had a large head which indicated hydrocephalus. The term hydrocephalus comes from the Greek words ‘hydro’ (water), and ‘cephalus’ (head); hence this condition is commonly referred to as ‘water in the brain’ or ‘water in the head’.

In a normal healthy person, a fluid known as cerebospinal fluid (CSF) continuously circulates through the brain and its ventricles (cavities) and the spinal cord. The fluid is continuously drained away into the body’s circulatory system. Disturbance or restriction of flow of CSF results in excess fluid in the central nervous system, causing the head to increase in size.

When Ann received the report, she became hysterical. She cried endlessly and asked many questions. She wanted to know if her baby was going to be normal and if she would survive like other normal kids. I tried to answer all her questions but noticed that she was extremely worried. I explained the scan report in detail to her and her husband and gave them reassurance.

I consulted the gynaecologist who advised her that she would deliver through a Caesarean section since the head was too big to pass through the birth canal.

Ann was taken to the ward where she and her husband were counselled about their baby’s condition. The following day I mobilised the relevant nurses to prepare Ann for theatre. The baby, a girl, was delivered by C-section. She had a very large head, and had some difficulties in breathing immediately she was delivered. She was therefore taken straight to the nursery.

Meanwhile Ann was taken to the maternity ward where care of her C-section wound continued. She was also given some drugs to prevent infections.

At the nursery, the baby was kept warm and put on oxygen and some antibiotics, as well as nasal-gastric (NG) tube feeding. On the second day, Ann could go to the nursery to see her baby.

Consent was sought from the baby’s father to engage a neurosurgeon to extract the excess fluid from the head to the abdominal cavity. Fortunately, the father said it was okay, thereby saving the baby’s life.

On the fifth day, the neurosurgeon took the baby to theatre for insertion of a shunt (this is a tube inserted by the neurosurgeon through the head to the abdominal cavity to release excess Cerebral Spinal Fluid (CSF) to the stomach. The fluid is eventually excreted).

The baby was later taken to the ward where she improved and could be fed with a cup and spoon. The mother was taught how to feed her baby with expressed breast milk. In addition, she was counselled on the care of the shunt to prevent infection. They were later discharged once the baby’s condition stabilised.

Through continuous follow up by the neurosurgeon, Ann’s baby is now three years old. When the baby was one-and-a-half- years, the shunt was misplaced and was replaced successfully. The family is supportive, which has enabled Ann’s baby enjoy life like any other human being.

With consistent support by relatives, nurses, doctors and counsellors, there is hope and less stigma for mothers who have hydrocephalic babies. This helps to reduce the mortality rate.

END: PG 11 /12

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