EIGHT MONTHS PREGNANT WITH ANENCEPHALY

I am more than eight months pregnant. I went for scan and they diagnosed “anencephaly” . When I saw my doctor, he said I’ll be induced. I am confused will the baby survive. Mrs. Ngozi J, Kaduna

Anencephaly is when there is absence of skull and brain or major portion of it. It is a form of neural tube defects. Other form of neural tube defects include: Encephaloceles, Hydranencephaly, Iniencephaly, Spina bifida.

Anencephaly occurs in about 1 in 10,000 births while in Nigeria it is higher at about 3 in 10,000 births.

The defect starts around the 23rd day to 26th day of pregnancy when the neural tube refuse to close. Baby born with anencephaly survive for only few hours or few days of extrauterine life. The longest surviving was in United States for three years and eleven days. Generally speaking anencephaly is not compatible with life.

Causes include deficiency of folic acid. This is why it is advisable for women of child bearing age to consume adequate folic acid. In women with previous history of anencephaly or neural tube defects the risk could be as high as 3%. In this situation the women are advised to be on folic acid 5mg daily prior to conception. Hereditary play a role in anencephaly but not well designed. Diseases like diabetes mellitus places the woman at the risk of anencephaly or neural tube defects especially poorly controlled prior to conception. A woman on anticonvulsant is at risk of having a fetus with neural tube defects

Generally speaking it is not compatible with life, if detected and confirmed by ultrasound it is advisable to terminate the pregnancy. With real time ultrasound nowadays the diagnosis is precise.

I will suggest you allow your doctor to induce you because there is no benefit of continuing the pregnancy.

And as it has been discussed start folic acid prior to your next conception to minimize the risk of recurrence

CAN RHESUS - & + GET MARRIED?

I am confused, is it true that Rhesus negative women should not marry a rhesus positive man? I am rhesus negative and my fiancé is rhesus positive we were told we cannot marry that we may not be able to have children. What do you advice please Rhesus negative women can marry anybody it is not like genotype where carriers are advised not to marry each other or marry HbSS but to marry HbAA. The main issue is women who are Rhesus negative whose husbands are Rhesus positive run the risk of Rhesus incompatibility. This manifest usually in the second or subsequent pregnancy if steps are not taken to avoid sensitization after the delivery of the first baby or after miscarriage.

The major thing is to collect Rhesus immunoglobulins or Rhogam immediately after delivery or latest within seventy two hours.

Where there are facilities the baby’s Rhesus grouping could be done immediately after birth and if the baby is Rhesus negative there will be no needs to give rhogam.

Let me emphasize that is not only after delivery that Rhogam need to be given but even after miscarriages and heavy bleeding during previous to prevent sensitization.

All women who are Rhesus negative and are pregnant should have indirect coomb’s test, that is to know whether the women are already sensitized or not. Those whose indirect coomb’s test is positive should be monitored closely and transfered to feta maternal unit with facilities to do intrauterine exchange blood transfusion in order to prevent possible intrauterine feral death.