YES
Dr Kumkum Mathur
Research Officer, Regional Centre for Clinical Research in Human Reproduction, Indian Council of Medical Research Seth GS Medical College & KEM Hospital
Women (and their babies) are not dying because of diseases we cannot treat They are dying because societies have yet to make the decision that their lives are worth saving Mahmoud Fathalla - 1997
Points to Discuss
Changing trends Safety of LSCS Evidence in the literature Skill and training of obstetricians today Rights of the unborn child Fetal pain Regressive belief that India is under developed and SOME babies are dispensable
Fetal Hydrocephalus
It is an abnormal build up of
cerebrospinal fluid (CSF) in the ventricles of the brain Incidence is 0.3-2.5/ 1000 live births Also quoted as 1 in 2000 live births May be isolated or associated with congenital malformation syndromes
Hydrocephalus: Management
Early diagnosis is the mainstay
management
With timely treatment, many children with hydrocephalus go on to lead normal lives
Why LSCS ?
No compression of head, therefore no compression of brain Delivery of baby in controlled manner No maternal injury by difficult vaginal delivery of large fetal head No need to resort to last minute panic and cephalocentesis
Elimination of exposure to and contamination by vaginal flora (important for postnatal shunt)
Destructive operations
To be condemned Only have a place in
books, history and archives No place for mutilating insensitive practices in modern obstetrics
main argument against these operations is that, in inexperienced hands, they are liable to be even more dangerous than Cesarean section
Intrapartum cephalocentesis
Akin to destructive
surgery Fraught with dangers Associated with high fetal morbidity and mortality Medicolegal and informed consent issues Cannot be recommended for fetus with a favorable prognosis
Recommendation : cepalocentesis use be limited to fetuses with severe associated anomalies ,which they concede is not always possible; all others to be delivered abdominally
Indian Data
Arch Gynecol Obstet. 2011 May;283(5):929-33. Epub 2010 Dec 31.
Destructive operations--a vanishing art in modern obstetrics: 25 year experience at a tertiary care center in India. Sikka P, Chopra S, Kalpdev A, Jain V, Dhaliwal L.
In 85,952 deliveries over 25 years The total number of destructive operations performed was 230 (0.26%). Advise individualized approach to each case of obstructed labor. Choose from available options to deliver the mother by the safest route without
literature
Most obstetricians will see less than 1 case per year Stick to the tried and true rather than struggling with something you are not familiar with
Cry of terror
Right to life
YES
YES
We too deserve to live
Points Discussed
Changing trends Safety of LSCS Evidence in the literature Skill and training of obstetricians today Rights of the unborn child Fetal pain Regressive belief that India is under developed and SOME babies are dispensable
destruction
Success stories.
http://www.hydroassoc.org http://www.hydrowoman.com