Delivery modes in case of fetal malformations

Abstract

An estimated 276,000 babies die within 4 weeks of birth every year, worldwide, from congenital anomalies. Better quality ultrasound screening can increase the detection of these fetal malformations in the prenatal period. Prenatal counseling for the pregnant woman and her family, regarding the nature of the disease and prognosis is necessary. Options for management in prenatal, perinatal, intrapartum, neonatal, and childhood periods need to be thoroughly discussed, so that the family can make an informed decision. A multidisciplinary approach is usually needed once a decision has been made to optimize fetal outcome, to plan for the timing and location as well as the mode of delivery. In most of the cases, vaginal delivery can be attempted. An elective cesarean delivery should be reserved for maternal concern of dystocia, certain fetal conditions that cesarean delivery will optimize perinatal outcome, or if the parents have a psychosocial determination to have a live-born infant.

Perinatal and Neonatal Outcomes of Patients Who Were Diagnosed with Neural Tube Defect in Midtrimester Fetal Ultrasound Scan and Refused Request for Termination of Pregnancy

“…Also, we observed that delivery mode was not associated with adverse neonatal outcomes. Inconsistently, some observational studies suggesting that cesarean delivery may provide a better outcome for babies with meningomyelocele (MMC) existed [14]. These studies suggested that cesarean delivery would be beneficial by keeping MMC sac intact, reducing bacterial contamination of the exposed neural tissue and also allow for a better preparation of the team (i.e., neonatologist and pediatric neurosurgeons).…”

Interventive Care: Uncertainty, Distributed Agency, and Cesarean Section in a Zika Virus Epidemic

“…In meetings, forums, and webinars, Secretariat representatives repeatedly reminded health care professionals and hospital administrators that unless some other complication arose that justified surgical delivery, women whose fetuses were diagnosed with microcephaly should give birth vaginally. Indeed, there is not enough evidence in the scientific literature to indicate that C-section improves neonatal outcomes for babies with microcephaly and other congenital malformations (Kuller et al 1996;Rio Grande do Sul 2016;Souza et al 2016;Wataganara et al 2017), 2 and there were no data about the relative risks and benefits of different modes of delivery in the specific case of CZS. Out of the 13 women in the cohort of mothers I interviewed who had given birth to children with CZS, however, all but three gave birth via cesarean.…”

“…2016; Wataganara et al. 2017), 2 and there were no data about the relative risks and benefits of different modes of delivery in the specific case of CZS. Out of the 13 women in the cohort of mothers I interviewed who had given birth to children with CZS, however, all but three gave birth via cesarean.…”

Just choice: a Danielsian analysis of the aims and scope of prenatal screening for fetal abnormalities

“…This can reduce the risk of injury to the fetus from vaginal delivery. Although the risk of fetal loss is less relevant in this instance, the procedure may still cause women a range of significant health complications (Anteby and Yagel 2003; Hadar et al 2011; Häger et al 2004; Sutton 2008; Villar et al 2007; Wataganara et al 2017). In view of these issues, it remains unclear whether routinely offering women prenatal screening for fetal abnormalities would not in fact detract from the pursuit of Just health .…”