Journal Mobile Options
Table of Contents
Vol. 26, No. 2, 2009
Issue release date: October 2009
Fetal Diagn Ther 2009;26:68–74
(DOI:10.1159/000238116)

Prognosis of Spina Bifida in the Era of Prenatal Diagnosis and Termination of Pregnancy

Aguilera S. · Soothill P. · Denbow M. · Pople I.
Fetal Medicine Research Unit, University of Bristol, St Michael’s Hospital, Bristol, UK

Individual Users: Register with Karger Login Information

Please create your User ID & Password





Contact Information











I have read the Karger Terms and Conditions and agree.

To view the fulltext, please log in

To view the pdf, please log in

Abstract

Objective: To evaluate the current outcome of a selected prenatally diagnosed spina bifida group. Materials andMethods: We analyzed and followed up 74 cases of prenatally diagnosed spina bifida. Results: Termination of pregnancy was chosen in 72% of the cases and 28% were live-born. Chromosomal defects were identified in 16%, although only 1.6% in isolated cases. Of the 21 live births, 3 died in the neonatal period. The other 18 (86%) were all alive after an average follow-up of 3 years and 6 months (range 5 months to 7 years and 4 months). From this group 11% are wheelchair-dependent, 87% of the patients older than 2 years of age are walking, 33% have had cerebral shunting and 72% have normal neurodevelopment. There was a better outcome in patients with closed defects; however, the rates of neuropathic bladder (50%) remain a concern. Conclusions: Even with prenatal diagnosis and a tendency towards apparently less severe defects in the cases in which the pregnancies continue, the prognosis in terms of morbidity needs to remain guarded.



Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

References

  1. Botto L, Moore C, Khoury M, Erickson J: Neural tube defects. N Engl J Med 1999;341:1509–1519.
  2. Date I, Yagyu I, Asari S, Ohmoto T: Long-term outcome in surgically treated spina bifida cystica. Surg Neurol 1993;40:471–475.
  3. Zurmohle UM, Homman T, Schroeter C, Rothgerber H, Hommel G, Ermert JA: Psychosocial adjustment of children with spina bifida. J Child Neurol 1998;13:64–70.
  4. Morris JK, Wald NJ: Prevalence of neural tube defect pregnancies in England and Wales from 1964–2004. J Med Screen 2007;14:55–59.
  5. Stoll C, Alembik Y, Dott B, Roth MP: Impact of prenatal diagnosis on live birth prevalence of children with congenital abnormalities. Ann Genet 2002;45:115–121.

    External Resources

  6. Chan A, Robertson EF, Haan EA, Ranieri E, Keane RJ: The sensitivity of ultrasound and serum alpha-fetoprotein in population-based antenatal screening for neural tube defects. South Australia 1986–1991. Br J Obstet Gynaecol 1995;102:370–376.
  7. Vos JMI, Offringa M, Bilardo CM, Lijmer JG, Barth PG: Sensitive and specific screening for the detection of spina bifida by echography in the second trimester: systematic review and meta-analysis. Ned Tijdschr Geneeskd 2000;144:1736–1741.
  8. Nicolaides KH, Campbell S, Gabbe SG, Guidetti R: Ultrasound screening for spina bifida: cranial and cerebellar signs. Lancet 1986;ii:72–74.
  9. Olde Scholtenhuis MAG, Cohen-Overbeek TE, Offringa M, Barth PG, Stoutenbeek Ph, Gooskens RH, Wladimiroff JW, Bilardo CM: Audit of prenatal and postnatal diagnosis of isolated open spina bifida in three university hospitals in The Netherlands. Ultrasound Obstet Gynecol 2003;21:48–52.
  10. Biggio JR, Owen J, Wenstrom KD, Oakes WJ: Can prenatal ultrasound findings predict ambulatory status in fetuses with open spina bifida? Am J Obstet Gynecol 2001;185:1017–1020.

    External Resources

  11. Peralta CFA, Bunduki V, Plese JPP, Figueiredo EG, Miguelez J, Zugaib M: Association between prenatal sonographic findings and post-natal outcomes in 30 cases of isolated spina bifida aperta. Prenat Diagn 2003;23:311–314.
  12. Sepulveda W, Corral E, Ayala C, Be C, Gutierrez J, Vasquez P: Chromosomal abnormalities in fetuses with open neural tube defects: prenatal identification with ultrasound. Ultrasound Obstet Gynecol 2004;23:352–356.
  13. Kennedy D, Chitayat D, Winsor EJ, Silver M, Toi A: Prenatally diagnosed neural tube defects: ultrasound, chromosome, and autopsy or postnatal findings in 212 cases. Am J Med Genet 1998;77:317–321.
  14. Appasamy M, Roberts D, Pilling D, Buxton N: Antenatal ultrasound and magnetic resonance imaging in localizing the level of lesion in spina bifida and correlation with postnatal outcome. Ultrasound Obstet Gynecol 2006;27:530–536.
  15. Aaronson OS, Hernanz-Schulman M, Bruner JP, Reed GW, Tulipan NB: Myelomeningocele: prenatal evaluation – comparison between transabdominal US and MR imaging. Radiology 2003;227:839–843.
  16. Kollias SS, Goldstein RB, Cogen PH, Filly RA: Prenatally detected myelomeningoceles: sonographic accuracy in estimation of the spinal level. Radiology 1992;185:109–112.
  17. Isaksen CV, Eik-Nes SH, Blaas HG, Torp SH: Comparison of prenatal ultrasound and postmortem findings in fetuses and infants with central nervous system anomalies. Ultrasound Obstet Gynecol 1998;11:246–253.
  18. Bruner JP, Tulipan N, Dabrowiak ME, Luker KS, Walters K, Burns P, Reed G: Upper level of the spina bifida defect: how good are we? Ultrasound Obstet Gynecol 2004;24:612–617.
  19. Johnston LB, Borzyskowski M: Bladder dysfunction and neurological disability at presentation in closed spina bifida. Arch Dis Child 1998;79:33–38.
  20. Mevorach RA, Bogaert GA, Baskin LS, Lazzaretti CC, Edwards MS, Kogan BA: Lower urinary tract function in ambulatory children with spina bifida. Br J Urol 1996;77:593–596.
  21. Brumfield CG, Aronin PA, Cloud GA, Davis RO: Fetal myelomeningocele. Is antenatal ultrasound useful in predicting neonatal outcome? J Reprod Med 1995;40:26–30.
  22. Knowles S, Parker S, Weckert RC, Furness ME: Gelating embedding and diagnostic ultrasound in the examination of the fetal and neonatal brain. Prenat Diagn 1989;9:73–75.
  23. Carroll SGM, Porter H, Abdel-Fattah S, Kyle PM, Soothill PW: Correlation of prenatal ultrasound diagnosis and pathologic findings in fetal brain abnormalities. Ultrasound Obstet Gynecol 2000;16:149–153.
  24. Ghi T, Pilu G, Falco P, Segata M, Carletti A, Cocchi G, Santini D, Bonasoni P, Tani G, Rizzo N: Prenatal diagnosis of open and closed spina bifida. Ultrasound Obstet Gynecol 2006;28:899–903.
  25. Wingate EE, Hancock JA, Churchwell KE, Pipkins MJ: Spina bifida: a review of the importance of sonography’s role in its detection. J Diagn Med Sonogr 2004;20:227.

    External Resources

  26. Hunt GM, Oakeshott P: Lifestyle in adults aged 35 years who were born with open spina bifida: prospective cohort study. Cerebrospinal Fluid Res 2004;1:4.
  27. Oakeshott P, Hunt GM: Long-term outcome in open spina bifida. Br J Gen Pract 2003;53:632–636.
  28. Fichter MA, Dornseifer U, Henke J, Schneider KTM, Kovacs L, Biemer E, Bruner J, Adzick NS, Harrison MR, Papadopulos NA: Fetal spina bifida repair – current trends and prospects of intrauterine neurosurgery. Fetal Diagn Ther 2008;23:271–286.
  29. Pierre-Kahn A, Sonigo P: Lumbosacral lipomas: in utero diagnosis and prognosis. Childs Nerv Syst 2003;19:551–554.
  30. Thorne JA, Pierre-Kahn A, Sonigo P: Antenatal diagnosis of spinal lipomas. Childs Nerv Syst 2001;17:697–703.


Pay-per-View Options
Direct payment This item at the regular price: USD 38.00
Payment from account With a Karger Pay-per-View account (down payment USD 150) you profit from a special rate for this and other single items.
This item at the discounted price: USD 26.50