Spina Bifida — UNC Fetal Care. What is Myelomeningocele or Spina Bifida? Myelomeningocele, more commonly known as Spina Bifida, is an open spinal cord defect, usually located in the lower back. In this defect there is an opening in the vertebral body or the bone that surrounds the spinal cord in the lower spine. This can be located anywhere from the upper back to the very bottom of the spine. The cause of myelomeningocele is unclear, but it is felt to be due to a failure of the neural tube to close during early fetal development. This abnormal closure occurs approximately 2- 3 weeks following conception. The result is a defect in the bones around the spinal cord, a defect in the tissues covering the spinal cord called the meninges, and a defect in the spinal cord. In Utero MeaningTo provide in utero fetal surgery guidelines for the Medical Department staff to reference when. consultation with practicing physicians in the. Define in utero. in utero synonyms. up to date, and is not intended to be used in place of a visit, consultation, or advice of a legal, medical. · Women who were exposed to diethylstilbestrol in utero may have structural. obstetric consultation may be required for pregnant women who had in. New Telehealth Service Offers Video Lactation Consultation Services. Prenatal Parenting Assures Good Mental Health Begins in the Womb. ![]() The spinal cord and surrounding tissues protrude through the opening in the spine and are not covered by skin. These tissues are then exposed to the amniotic fluid during pregnancy, and this exposure and potential risk of trauma to these areas during in utero development can result in further nerve injury. The most common complications from spina bifida are a disruption in the nerves at and below the affected area. These defects can result in abnormal sensation and loss of muscle control or movement from the level of the defect and lower. This can include problems with movement in the legs and the hips, problems with control of the bladder or bowel function, and problems with sensation from the level of the lower chest to the feet. The degree of these impairments is related to where on the spine the lesion is located, referred to as the spinal ‘level’ of the lesion. The location of the lesion is based on the level of the upper most vertebra that is abnormally formed. A second complication from open Spina Bifida results from decreased in pressure in the brain or intracranial pressure. This results in a downward movement of the lower portion of the brain, the cerebellum, towards the back and spine, into the spinal column. As a result of this herniation, a blockage in flow of the normal cerebrospinal fluid in the brain can occur, leading to excess fluid building up in the brain, called hydrocephalus. Hydrocephalus can result in further developmental problems in the brain. Myelomeningocele is fortunately rare but remains one of the more common birth defects. Myelomeningocele occurs in the United States in 0. Baby In Utero![]()
What is Myelomeningocele or Spina Bifida? Myelomeningocele, more commonly known as Spina Bifida, is an open spinal cord defect, usually located in the lower back. Neural tube defects can be part of a chromosome abnormality, a genetic syndrome, or as an isolated birth defect. When isolated, myelomeningocele are thought to be multifactorial in origin, meaning both environmental and genetic factors play a role in their development. Various risk factors have been identified that may increase the risk for neural tube defects. These can include diabetes in the mother or a mother’s use of certain medications including diuretics and seizure medications. Low dietary folic acid intake has also been implicated in an increased risk for Spina Bifida. ![]() In addition, mothers with certain defects in folic acid metabolism carry an increased risk for Spina Bifida. Folic acid supplementation is known to decrease the incidence of neural tube defects; however, it is not sufficient to eliminate the condition. Most children with spina bifida are born to women with no risk factors. How is spina bifida diagnosed? What testing is recommended for the fetus (baby) when spina bifida is suspected? There are two main methods for evaluating for spina bifida during pregnancy, maternal blood testing and ultrasound. In the first case, elevated levels of alpha fetal protein found in mother’s blood can suggest an increased risk for spina bifida. This blood test is usually performed during the 2nd trimester of pregnancy (1. Down syndrome screening. In cases of open neural tube defects, such as spina bifida, AFP is noted to be elevated 2 to 7 times over the unaffected population. MSAFP is elevated in 8. When an elevated MSAFP is found on maternal blood screening, a detailed, or ‘targeted,’ ultrasound is then performed to evaluate for an open neural tube defect. Ultrasound is very sensitive and accurate for the detection of myelomeningocele and open Spina Bifida. In most cases, the open spinal defect with associated fetal head abnormalities is identified on ultrasound. The ultrasound evaluation of the baby with spina bifida will identify abnormally shaped and open vertebrae in the affected portion of the fetal spine. A sac containing the dura or menenges, the covering of the spinal cord, can often be identified on the ultrasound. Another finding that can be seen with spina bifida is abnormal positioning of the feet called “clubbed feet”. Fetal head abnormalities are also common findings in spina bifida. Such findings may include ventriculomegally, or enlargements in the fluid containing portions of the fetal brain, abnormal size and shape of the fetal head with narrowing of the bones in the front portion of the fetal skull called the ‘Lemon Sign,’ or an abnormal shaped cerebellum called the ‘banana sign.’ This abnormality of the cerebellum, termed the ‘Chiari Malformation’ results from downward displacement of the cerebellum into the upper portion of the spinal canal. When open spina bifida is suspected, a very detailed or targeted ultrasound by high- risk pregnancy physicians, such as Maternal Fetal Medicine physicians, in centers that care for high- risk pregnancies is recommended. This ultrasound is performed to evaluate the presence of other fetal abnormalities and assess the spinal level of the lesion. A detailed ultrasound is important to exclude other fetal abnormalities that can alter the overall prognosis. Between 2- 1. 5% of cases of open spina bifida also have karyotype or single- gene disorders that may detectable at time of amniocentesis or with further testing. The risk of a chromosome abnormality is increased when additional fetal abnormalities are identified. The presence of chromosome abnormalities also highly alters the prognosis, thus amniocentesis is typically recommended in most cases of spina bifida. In certain cases, a fetal MRI may be performed which can further clarify the overall spinal level of the lesion as well as identify subtle brain abnormalities. Once a diagnosis is suspected, a consultation is performed with Maternal Fetal Medicine and Genetic Counselors to review the diagnosis and discuss the findings on ultrasound. Management of pregnancy with Spina Bifida. At UNC, management of babies with suspected spina bifida is undertaken by a multidisciplinary team of specialists with extensive experience in the care of pregnancies and children affected by spina bifida. The team approach is coordinated by the UNC Center for Maternal and Infant Health in which all parents are matched with a care coordinator to help guide and plan care through the course of the pregnancy and childhood. This multidisciplinary team includes specialists in Maternal Fetal Medicine (‘High- risk Obstetrics), Genetic Counseling, Pediatric Neurosurgery, Physical Medicine and Rehabilitation, Social Workers, and Neonatologists. Prenatal consultation with each of these specialists will be done to discuss the overall prognosis, care during the pregnancy, and care in the neonatal period, as well as to establish long- term care for the baby. During pregnancy, serial ultrasounds approximately every 4- 6 weeks will be performed to evaluate the overall growth of the baby and assess for the development of hydrocephalus. There is no cure for spina bifida. In some cases, as outlined here [link to fetal surgery section], the baby may be a candidate for in utero repair of the meningomyelocele which may improve the long term outcome in selected cases. This procedure is available at UNC and your care team will evaluate you and your baby to determine if this is the best option for you. It is recommended that all babies with spina bifida be delivered at a hospital that can provide immediate specialty evaluation and care, including neurosurgical care, for the baby. At this time, most babies with spina bifida are delivered at term, either by cesarean delivery or vaginally, after the natural onset of labor. The route of delivery, whether vaginal or by cesarean, remains controversial and may be individualized based on the specific baby and mother. As older literature suggests a difference in 1- 2 levels of function between vaginal delivery and cesarean (slightly worse function after vaginal delivery compared to cesarean), some institutions recommend delivery by cesarean for all patients with spina bifida. However, this data likely does not account for improved neonatal surgical techniques, and may not improve the outcome for the baby in all cases and delivery is individualized. Thus, in most cases of otherwise normal fetal development, normal head size and head first presentation with typical lesions many offer vaginal delivery. Given the significant long- term risks of complications, need for surgical intervention and risk of poor neurodevelopmental outcome when the diagnosis is made < 2. Newborn care. At the time of delivery, either by cesarean or by a vaginal delivery, neonatal critical care staff including neonatologists will be present in the delivery room. Immediately upon delivery, the baby will be examined, and the defect in the spine is covered with sterile dressing. After visiting with the parents, the baby is then taken to the Newborn Critical Care Center. In most instances, surgical repair of the spina bifida is undertaken within 7. In the first few days of life, serial ultrasounds and a MRI of the fetal head will be performed, and these may need to be repeated to evaluate for the development of hydrocephalus. In the majority of cases, sometimes only after initial repair, hydrocephalus develops and requires placement of a ventriculo- peritoneal shunt.
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