| Fetal diagnosis | • Acardia • Anencephaly • Bilateral renal agenesis • Holoprosencephaly • Intrauterine fetal demise • Pulmonary hypoplasia • Thanatophoric dwarfism | | --- | --- | | Obstetric management | • Vaginal delivery • No fetal monitoring (isn’t indicated nor affects management | | Neonatal management | • Palliative care if not stillborn • The anomaly is lethal thus neither antenatal corticosteroids nor magnesium sulfate is indicated. |
<aside> 💡 principle behind labor management of patients with lethal fetal anomalies is to minimize maternal morbidity and mortality→ obstetric care for these patients is maternally focused. Vaginal delivery has a lower risk for maternal complications compared to cesarean delivery (eg, hemorrhage, infection, pulmonary embolism); therefore, it is the delivery modality of choice.
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<aside> 💡 A breech presentation is typically an indication for cesarean delivery because it decreases the risk of fetal trauma and asphyxia associated with vaginal delivery (eg, head entrapment). However, in fetuses with lethal anomalies in which entrapment does not affect fetal outcome, vaginal delivery is preferred due to the increased risk of maternal complications associated with cesarean delivery.
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