Overview
Spina bifida is a neural tube defect characterized by incomplete closure of the spinal column, leading to potential neurological deficits and varying degrees of disability depending on the severity 1.Diagnosis
Prenatal diagnosis often achieved via maternal serum alpha-fetoprotein (MSAFP) screening and detailed ultrasound 1.
Magnetic resonance imaging (MRI) can provide detailed anatomical assessment postnatally 1.
Fetal MRI may be used to further evaluate severity and associated anomalies 1.Management
First-line: Surgical closure of the myelomeningocele in utero may be considered to reduce postnatal complications 1.
Postnatal: Early surgical intervention for hydrocephalus management, often involving ventriculoperitoneal (VP) shunt placement 1.
Supportive care: Physical therapy, orthopedic interventions, and multidisciplinary care teams including neurology, urology, and rehabilitation specialists 1.Special Populations
Pregnancy: Maternal-fetal medicine (MFM) specialists more frequently offer growth ultrasounds and neonatal hospice consultations compared to non-MFM providers 1.
Pediatrics: Neonatal management focuses on preventing complications such as infection, optimizing neurological outcomes, and addressing orthopedic issues 1.Key Recommendations
Maternal-fetal medicine specialists should be involved in pregnancies complicated by fetal spina bifida to optimize prenatal care and counseling 1 (Evidence: Moderate).
Offer detailed fetal imaging (ultrasound, MRI) to assess the extent of the defect and associated anomalies 1 (Evidence: Strong).
Consider antenatal surgical intervention for myelomeningocele closure to potentially improve outcomes 1 (Evidence: Moderate).
Postnatal management should include prompt surgical intervention for hydrocephalus and comprehensive multidisciplinary support 1 (Evidence: Strong).References
1 Dotters-Katz SK, Smid MC, Mcelwain C, Kuller JA, Schulkin J. Obstetric practice patterns in pregnancies complicated by fetal trisomy 13 or 18. The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians 2018. link