What are the possibilities and likely scenarios?
If hydrocephalus is isolated with no serious underlying chromosomal aberration, the prognosis is not so bad.
The progression of this condition will be closely monitored and delivery will be planned, depending on how fast the size of the head is increasing. In most cases, delivery is undertaken when fetal lung maturity is reasonably adequate. This could be between thirty and thirty-four weeks of gestation. Occasionally, the pregnancy is allowed to continue further if the progression of the condition is assessed to be very slow.
Delivery is usually, but not always, by caesarean section.
Is there any possibility of hydrocephalus resolving spontaneously?
This has been known to happen but is evidently very rare.
What if progression of the condition is rapid and the fetus is still too immature to survive outside the womb?
There are various methods of trying to relieve pressure on the fetal brain. The most popular is insertion of a shunt, which allows the trapped fluid to flow into the amniotic cavity. It also prevents subsequent build-up.
A decision to perform this procedure is not taken lightly since up to 10 per cent of fetuses are lost as a direct result of the procedure.
It may be unwise to consider a shunt for a fetus that has got other major organ abnormalities and whose prognosis is poor anyway.
What are the prospects of babies diagnosed to have hydrocephalus?
Variable. It has to be emphasized that a respectable percentage of these children grow up to be normal both physically and in intellectual attainment. Others have mild learning difficulties but some will be profoundly retarded. This last group forms roughly 20 per cent of the total. Early shunting is known to improve the prospects of intellectual outcome.
Is it true that hydrocephalus can occur after birth?
Yes. The same kind of injuries that lead to hydrocephalus in the womb can occur in early infancy and cause this condition to develop.
Meningitis, or a more serious infection termed "meningo-encephalitis", if occurring in the early months of life, can cause sufficient scarring in the fluid channels in the brain to cause obstruction.. Hydrocephalus may follow.
Bleeding inside the brain substance may also lead to the same consequence. Premature infants are particularly prone to this.
Is there any way that this can be prevented?
Meningitis needs to be recognized and treated early and aggressively if such devastating consequences are to be avoided.
For preterm infants, it is strongly believed that administration of vitamin K soon after birth significantly reduces the risk of spontaneous bleeding inside the brain (as well as in other organs).
How does vitamin K work?
It helps to accelerate maturation of the clotting system in the body. Since this system is immature and not very efficient in the newborn (and more so, in the premature infant), the risk of accidental bleeding in vital organs - including the brain and lungs - is substantial. In fact, vitamin K is recommended to be given to all babies at birth, regardless of the gestation.
Where does folic acid come in?
Folic acid is now known for certain to reduce the occurrence of neural tube defects such as spina bifida and the others. For it to be effective, supplements need to be taken in the period before conception and through the weeks of the first trimester of pregnancy. There is no doubt that dietary deficiency of folic acid (or deficiency caused by any other factors) increases the risk of neural tube defects.
Epileptic women taking valproic acid (sodium valproate) are particularly advised to use folic acid in the period leading to conception, since use of this drug is associated with a high rate of neural tube defects.
Is hydrocephalus a neural tube defect as well?
No. Folic acid therefore has no role to play in prevention of this condition.