Anencephaly with Prior Caesarean Section: A Management Dilemma for Lethal Fetal Condition to Perform Labor Induction
Abstract
Introduction: A failure of cranial neuropore closure during the third to fourth week of gestation is called anencephaly. It leads to the lack of a significant part of the brain, skull, and scalp. The recommended method of delivery in lethal conditions, such as anencephaly, is vaginal delivery. This case report describes anencephalic pregnancy with a history of prior cesarean section. Labor induction held a dilemma to perform, but cesarean section poses a risk of morbidity to the mother and will not improve fetal outcomes.
Case Illustration: A 37-year-old woman, G4P3A0, 26-27 weeks of pregnancy, presented with a planned termination of pregnancy. The patient was known to have congenital malformation and anencephaly. The patient had a history of prior cesarean section. During admission, the patient showed no signs of delivery. The patient was then planned for labor induction with misoprostol 50 mcg on the posterior fornix. The delivery outcome was no uterine rupture or significant bleeding.
Conclusion: Vaginal delivery is the first choice for the delivery method in cases with poor prognosis. Avoiding a cesarean section will protect the mother from further morbidity from a cesarean section.
Anensefali dengan Riwayat Seksio Sesarea: Dilema Manajemen untuk Kondisi Janin Yang Lethal dalam Melakukan Induksi Persalinan
Abstrak
Pendahuluan: Kegagalan penutupan neuroporus kranial selama minggu ketiga hingga keempat kehamilan disebut anensefali. Kondisi ini menyebabkan hilangnya sebagian besar otak, tengkorak, dan kulit kepala. Metode persalinan yang direkomendasikan dalam kondisi janin yang tidak bisa bertahan hidup, seperti anensefali, adalah persalinan melalui vagina. Laporan kasus ini akan menggambarkan kehamilan dengan anensefali pada pasien dengan riwayat seksio sesarea sebelumnya. Induksi persalinan menimbulkan dilema untuk dilakukan, namun seksio sesarea meningkatkan risiko morbiditas bagi ibu tanpa memperbaiki hasil pada janin.
Ilustrasi Kasus: Seorang wanita berusia 37 tahun, G4P3A0, usia kehamilan 26 - 27 minggu, datang dengan rencana terminasi kehamilan. Pasien diketahui memiliki malformasi kongenital dan anensefali. Pasien juga memiliki riwayat seksio sesarea sebelumnya. Saat masuk rumah sakit, pasien tidak menunjukkan tanda-tanda persalinan. Pasien kemudian direncanakan untuk induksi persalinan dengan misoprostol 50 mcg yang dimasukkan ke fornix posterior. Hasil persalinan tidak menunjukkan adanya ruptur uterus atau perdarahan yang signifikan.
Kesimpulan: Persalinan melalui vagina adalah pilihan pertama untuk metode persalinan pada kasus dengan prognosis buruk. Menghindari seksio sesarea akan melindungi ibu dari morbiditas lebih lanjut akibat seksio sesarea.
Kata kunci: Anensefali; Induksi; Letal; Manajemen Persalinan; Riwayat Seksio Sesarea
Keywords
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DOI: http://dx.doi.org/10.24198/obgynia.v7i3.756
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