The management of fetal hydrocephalus

The management of 53 consecutive documented cases of fetal hydrocephalus is presented. Hydrocephalus was isolated in nine cases (17%) and associated with other abnormalities in 44 (83%). Our success in diagnosing abnormalities associated with hydrocephalus improved from the time period 1977 through 1981 to that of 1982 through 1983. In this series, management consisted of termination of pregnancy, 14 (26%); ventriculoamniotic shunt placement and cesarean section, two (4%); cephalocentesis and cesarean section, two (4%); cesarean section without cephalocentesis or ventriculoamniotic shunt placement, 18 (34%); cephalocentesis and vaginal delivery, nine (17%); and vaginal delivery without cephalocentesis, eight (15%). The outcomes were spontaneous abortion, 14 (26%); intrapartum death, eight (15%); postnatal death, 16 (30%); currently alive, 15 (28%). Current approaches to the management of fetal hydrocephalus are discussed, and areas of therapeutic uncertainty are delineated.