HYDROCEPHALUS

  • Not an indication for C/S per se
  • Avoid C/S

BREECH PRESENTATION

  • Vaginal delivery
  • Deliver the body
  • Leave body hanging
  • Puncture the head suprapubically with a wide bore needle
  • Drain the cerebrospinal fluid
  • Deliver the collapsed head with Mauriceau-Levret’s maneuver
Suprapubic Puncture of Hydrocephalic Head

CEPHALIC PRESENTATION

  • Puncture the head with a wide bore needle
    • Through the open cervix
    • Suprapubically
      • Technically easier

TRANSVERSE

  • Internal version and extraction on one foot or both feet
  • Deliver as a breech presentation  

AT CESAREAN SECTIO (in case of missed diagnosis)

  • Puncture head and drain cerebrospinal fluid before attempting to extract it through the uterine incision
  • Troublesome vaginal and/or uterine tears may otherwise be the result

Puncture and drainage of the head is not harmful to the child

URINARY RETENTION

If catheterization of a full bladder fails:

  • Try to insert a rigid catheter
  • Try to insert a metal catheter
  • Perform a suprapubic puncture with a wide bore needle.
Suprapubic Bladder Puncture