P21.04: The role of cephalocentesis in the management of the severely hydrocephalic fetus
Bibliographic record
Abstract
To review the role of cephalocentesis in the fetus with severe hydrocephalus and to report on perinatal, neonatal and neurodevelopmental outcomes in survivors at two tertiary care centers. This retrospective descriptive study identified all cases of cephalocentesis at the Fetal Medicine Unit, Mount Sinai Hospital, Toronto, Ontario and the National Maternity Hospital, Dublin, Ireland between 1985 and 2011. Outcome information was obtained from maternal and pediatric charts, procedure, labor and delivery, and autopsy records (in the case of stillborn fetuses). Antenatal ultrasound findings, fetal karyotype, the method and route of cephalocentesis were evaluated. 55 cases of cephalocentsis were identified. The method of cephalocentesis was not standardized. All patients had an antenatal ultrasound that diagnosed severe hydrocephalus. The mean gestational age at diagnosis and delivery were 30 and 35 weeks respectively. Thirty four of 55 (62%) underwent induction of labor. Two patients were delivered by cesarean section. Twenty three underwent spontaneous vaginal delivery, 21 breech vaginal deliveries and 9 operative vaginal deliveries. 11 (20%) patients had termination of pregnancy with fetal intracardiac KCl injection prior to delivery. 27 (61%) of fetuses were stillborn (excluding the KCl terminations). There were 13 (30%) neonatal deaths. Four (9%) children survived cephalocentesis and delivery—with mild to severe neurodevelopmental morbidities noted on followup examination. The mortality rate associated with cephalocentesis and delivery was (40/44) 91%. Prenatal and intrapartum cephalocentesis performed for severe hydrocephalus is associated with a high mortality rate, however survival is possible. Parents should receive multidisiplinary counseling regarding mode of delivery, termination of pregnancy, perinatal and neonatal outcomes prior to intervention.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".