Association between prenatal sonographic findings and post‐natal outcomes in 30 cases of isolated spina bifida aperta

Abstract

This study presents 30 cases of fetal isolated spina bifida aperta (SBA) to identify prenatal ultrasound findings that could predict the prognosis. Comparisons between surviving patients who had normal (group 1) and abnormal (group 2) post-natal neurological outcomes were made for three different prenatal signs, that is, site of vertebral lesion, presence and degree of ventriculomegaly and presence of talipes. The site of the lesion was the most significant outcome predictor, as high spinal dysraphisms were observed in 2 patients (2/7-28.6%) in group 1 and in 15 patients (15/19-79.0%) in group 2 (p = 0.03). The presence of fetal ventriculomegaly was associated with impaired post-natal neurological development, as it occurred in 4 patients (4/7-57.1%) in group 1 and in 18 patients (18/19-94.7%) in group 2 (p = 0.04). The presence of talipes did not significantly differ between the two groups. Patients with abnormal intellectual outcome (8/26-30.8%) had significantly greater (p = 0.018) lateral ventricle/hemisphere ratios (mean = 0.74, standard deviation = 0.13) than those with normal intellectual development (mean = 0.54, standard deviation = 0.18). Mean post-natal follow-up was at 23 months (standard deviation = 15 months).

Severe Fetal Hydrocephalus with and without Neural Tube Defect: A Comparative Study

“…The mortality that we observed during the 1st year of life (including intrauterine deaths and deaths of babies with malformations incompatible with life) was very high: 36% in the group with NTD and 59% in the group without NTD (p = 0.077; Fisher's exact test). The neonatal mortality was 18% in the group with NTD, similar to that of previous reports (7-21%) [15][16][17] . The neonatal mortality was 35% in the group without NTD which is also in agreement with findings reported in the literature (21-38%) [10,12,14,24] .…”

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

“…The likely intellectual outcome tends to be worse when the degree of ventriculomegaly is more severe [9,20,21] . We found exactly the same spinal level prenatally versus postnatally in 61% of the cases, and the differences in the remaining cases were less than 2 spinal levels (similar to the published literature) [11,14,16,17] . We also confirmed the previously published trend for prenatally diagnosed levels to be lower (1 or 2 levels) than the postnatal assessment [10,11,14,16] .…”

“…It has been widely published that prenatal ultrasound usually has good agreement with the postnatal/postmortem findings in terms of the level of spinal defect, cranial changes and talipes [11,[14][15][16][17][18] . The importance of the spinal level and ventriculomegaly to predict outcome is 1 n = 21 for TOP, n = 2 for neonatal deaths.…”

“…widely used. Lower spinal levels increase the chance that the child will be able to walk [10,11] , but this is also related to a higher incidence of neuropathic bladder [14,19,20] . The likely intellectual outcome tends to be worse when the degree of ventriculomegaly is more severe [9,20,21] .…”

“…When the ultrasound findings showed a spinal defect with cerebral signs, ventriculomegaly and upper lesions, the patients were counseled about possible postnatal events in accordance to published series [9][10][11] . The risks quoted were: 30% risk of moderate mental handicap, 30% risk of wheelchair-dependency, 70% risk of urinary incontinence, 30% risk of urinary and fecal incontinence, and 80-90% risk of cerebral shunting.…”