Cephalocentesis with the modified Smellie's perforator

• Published in: International journal of gynecology and obstetrics Vol. 76; no. 2; pp. 203 - 206
• Main Authors: Chanrachakul, B, Chittachareon, A, Herabutya, Y
• Format: Journal Article
• Language: English
• Published: Shannon Elsevier Ireland Ltd 01-02-2002; Elsevier Science
• Subjects: Abnormalities, Multiple - diagnostic imaging; Abortifacient Agents, Nonsteroidal - therapeutic use; Abortion, Induced; Adult; Biological and medical sciences; Cephalocentesis; Delivery. Postpartum. Lactation; Extraction, Obstetrical - instrumentation; Female; Fetal Diseases - diagnostic imaging; Gynecology. Andrology. Obstetrics; Humans; Hydrocephalus; Hydrocephalus - diagnostic imaging; Management; Medical sciences; Misoprostol - therapeutic use; Obstetrical techniques; Polyhydramnios - diagnostic imaging; Pregnancy; Pregnancy Trimester, Third; Skull; Smellie's perforator; Surgical Instruments; Ultrasonography, Prenatal; Smellie's perforator; Management; Hydrocephalus; Cephalocentesis; Human; Nervous system diseases; Induced delivery; Misoprostol; Cerebral disorder; Case study; Fetal diseases; Surgery; Surgical decompression; Central nervous system disease; Skull; Female; Fetus; Technique; Hydrocephaly; Prostaglandin derivatives
• ISSN: 0020-7292; 1879-3479
• DOI: 10.1016/S0020-7292(01)00561-6

A 37-year-old pregnant woman, gravida 2, para 0, was referred to Ramathibodi Hospital at 31 weeks of gestation with the diagnosis of hydrocephalus and polyhydramnios. Repeated ultrasound scans revealed hydrocephalus with macrocephaly (BPD=10.3 cm), polyhydramnios (AFI=31.5), and a suspected esophageal atresia. After counseling, both parents decided not to pursue the pregnancy and requested vaginal delivery. They decided against transabdominal, ultrasonic-guided cephalocentesis because of its invasiveness, patient's awareness, and pain. Skull decompression with the modified Smellie's perforator was performed after five 400-μg doses of misoprostol were applied to dilate the cervix. The post-partum condition was uneventful. Fetal skull decompression with the modified Smellie's perforator and misoprostol for cervix dilation is a useful, simple, and safe procedure that can be performed with no previous experience.