Ethical analysis of the intrapartum management of pregnancy complicated by fetal hydrocephalus with macrocephaly.

The intrapartum management of pregnancy complicated by fetal hydrocephalus with macrocephaly often confronts the physician with a complex array of moral obligations to both mother and fetus that may sometimes come into direct conflict. The authors analyze the component beneficence-based and autonomy-based obligations of these conflicts and offer strategies for resolving them for each of three clinical subgroups. For isolated fetal hydrocephalus, we argue that cesarean section should be performed except when the woman with full informed consent unwaveringly refuses. For fetal hydrocephalus with severe associated abnormalities (those incompatible with postnatal survival or those characterized by the virtual absence of cognitive function), we propose that cephalocentesis followed by vaginal delivery is permissible. For fetal hydrocephalus with other associated abnormalities, we suggest that the permissibility of cephalocentesis followed by vaginal delivery depends on the degree of severity of the associated abnormalities.