Anencephaly

What is anencephaly?
This is a serious condition in which there is virtually no brain and most of the skull vault is missing.

What are the prospects for such a baby?
Invariably fatal. Without intervention, a full-term anencephalic baby dies shortly after birth.

Can anencephaly occur together with spine bifida?
Yes. Such a concurrence is not uncommon.

How is anencephaly diagnosed?
If an ultrasound scan is performed after about twelve weeks of gestation, the anomaly is fairly obvious. At eighteen to twenty weeks, when most routine scans are performed, it is almost impossible to miss an anencephaly. It provides a definitive diagnosis.
Alternatively, like in "open" spina bifida, the initial suspicion may arise following a "triple" or a "double" test. Levels of the chemical AFP (aFP) are markedly elevated with anencephaly, as they are with the open type of spina bifida. In fact, these two conditions are the most common causes of raised AFP.

How common is anencephaly?
Anencephaly is as common as spina bifida and in some areas it has been observed to be more common. The incidence ranges anywhere between one and six per 1000 deliveries.
For some unclear reason, there is a racial difference as well. Anencephaly is less common among the black community and people from south-east Asia, compared to Caucasians.
Like spina bifida, anencephaly affects girls more than boys.

Is anencephaly associated with underlying genetic or chromosomal disorders?
Occasionally, yes. In such cases, even the recurrence rate may be quite high; up to one in four (25%).

Once anencephaly has been diagnosed, what then?
Anencephaly is invariably lethal. In fact, many such babies are stillborn and those born alive survive for minutes or, at most, hours. With such prospects, the doctor will advise the only seemingly practical avenue which is pregnancy termination.
The mother - for moral, religious or other reasons - may decline and decide to continue with the pregnancy. In such a case, she is given the required antenatal care and support. Most mothers opt for termination.

What are the likely problems if she opts to continue with such a pregnancy?
There are no specific or unique problems associated with an anencephalic pregnancy. However, this pregnancy is more prone to such complications as polyhydramnios. This simply means excessive amounts of amniotic fluid. This can be very uncomfortable and physically distressing. Another potential complication is fetal demise and subsequent stillbirth.

Are there any potential labour problems?
There is a slight increase in the incidence of pregnancy con tinuing beyond term in such cases. There is also an increased tendency for the fetus to be lying abnormally. This may render labour and vaginal delivery difficult, if not impossible. Apart from these, labour should be expected to be normal.

If an anencephalic baby is born alive, will attempts be made to keep him or her so?
This is neither desirable nor justifiable. It will be cruel to both the mother and the baby to embark on such a pointless endeavour. An anencephalic baby should always be allowed to die peacefully.