Case narrative
I had been at the medical center only a short time when I was asked by one of the physicians in the maternal–fetal unit to consult on what was said to be an “abortion” problem. A 22-year-old married woman, I was told, a Mrs. Judy Nelson, had been referred by her own obstetrician for evaluation and management of her first pregnancy, which was thought to be problematic, although the obstetrician was unsure precisely how to read the several ultrasounds (US) she had performed. Mrs. Nelson's pregnancy was thought to be about 22 + 2 weeks gestational age.
Physicians and specialists in our maternal–fetal unit confirmed the estimated fetal age. They also noted a myelomeningocele, however, along with possible ventricular dilatation – “spina bifida” with patent spinal lesion and protrusion. Presumably, Mrs. Nelson's own obstetrician had seen enough to refer her to our unit, although uncertainty made her reluctant to tell her patient very much.
Informed of these results, the woman was also told that the radiologists could not be “completely certain” of many aspects of that diagnosis; for greater accuracy, serial USs – several taken over aweek or so –would be needed to determine whether, beyond the spinal protrusion, the apparent hydrocephalus was growing worse.
The woman was told she faced several options in light of the diagnosis by the maternal–fetal specialist who had taken her case. On the one hand, she could “continue with the pregnancy,” but if developing hydrocephalus were to become clear, there was a “real chance” that she would have to undergo a cesarian. When she asked why that might happen, she was told that the fetal head size might preclude vaginal delivery.