Audit of prenatal and postnatal diagnosis of isolated open spina bifida in three university hospitals in The Netherlands

Scholtenhuis, M. A G Olde; Cohen–Overbeek, Titia E.; Offringa, Martin; Barth, Peter; Stoutenbeek, P.; Gooskens, R. H. J. M.; Wladimiroff, J. W.; Bilardo, C. M.

doi:10.1002/uog.3

Cited by 22 publications

(16 citation statements)

References 24 publications

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“…We identified 15 articles meeting inclusion criteria using the search strategy (Harmon et al, 1995;Forrester and Merz, 2000;Waller et al, 2000;Olde Scholtenhuis et al, 2003;Biggio et al, 2004;Garne et al, 2005;Ghi et al, 2006;Nikkila et al, 2006;Tairou et al, 2006;Poretti et al, 2008;Aguilera et al, 2009;Amari et al, 2010;Lu et al, 2011;Machado et al, 2012). One additional article was found using Google Scholar (this article had cited one of the articles identified using the search strategy) (Adama van and one article was known to the authors and included (Shulman et al, 1994).…”

Section: Resultsmentioning

confidence: 99%

Pregnancy termination following prenatal diagnosis of anencephaly or spina bifida: A systematic review of the literature

Johnson¹,

Honein²,

Flanders³

et al. 2012

Birth Defects Research

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Background-In regions where prenatal screening for anencephaly and spina bifida is widespread, many cases of these defects are prenatally diagnosed. The purpose of this study was to estimate the frequency of termination of pregnancy (TOP) following prenatal diagnosis of anencephaly or spina bifida and to investigate factors associated with TOP that might lead to selection bias in epidemiologic studies.

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Section: Resultsmentioning

confidence: 99%

Pregnancy termination following prenatal diagnosis of anencephaly or spina bifida: A systematic review of the literature

Johnson¹,

Honein²,

Flanders³

et al. 2012

Birth Defects Research

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“…As to spina bifida, termination rates are 55 and 59%, respectively. Over a decade ago, the termination rate for spina bifida in the Netherlands was as low as 29% (2002-2004) [38]. That rate, however, is misleading because the number originates from an era when second-trimester ultrasound screening in the low-risk population was not yet introduced.…”

Section: Discussionmentioning

confidence: 99%

“…That rate, however, is misleading because the number originates from an era when second-trimester ultrasound screening in the low-risk population was not yet introduced. On closer look, even then 90% of parents with a fetus with spina bifida aperta diagnosed prior to 24 weeks requested TOP [1,36,38]. …”

Section: Discussionmentioning

confidence: 99%

Prenatal Diagnosis and Patient Preferences in Patients with Neural Tube Defects around the Advent of Fetal Surgery in Belgium and Holland

Ovaere

Eggink²,

Richter³

et al. 2014

Fetal Diagn Ther

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Introduction: We review the characteristics and prenatal choices of patients recently evaluated for neural tube defects (NTD) at two tertiary units. The prenatal diagnosis of NTD allows parents to consider all prenatal options. In selected cases of spina bifida aperta this also includes fetal surgery, which we started offering after combined ‘in-house' and ‘exported' training. Material and Methods: This is a retrospective review of prospectively collected data on NTD diagnosed over the last 8 years and recent fetal surgery referrals. Results: A total of 167 patients were referred for assessment at a median of 19 weeks. Cranial lesions were diagnosed significantly earlier than spinal lesions. Of the open spinal lesions, 77% were isolated. Of these, 22% were managed expectantly and 1 (1%) had fetal surgery. There was no correlation between parental decisions on prenatal management with disease-specific severity markers. We had 14 fetal surgery referrals, all but 1 from beyond our typical referral area; 6 of the assessed patients were operated on, 4 were expectantly managed and 4 requested termination of pregnancy (TOP). These pregnancy outcomes were in the expected range. Discussion: Open spina bifida is mainly diagnosed in the second trimester and 76% of subjects request TOP, irrespective of the severity indicators. The number of local patients considering fetal surgery is low.

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“…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] . 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] .…”

Section: Discussionmentioning

confidence: 99%

“…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.…”

Section: Methodsmentioning

confidence: 99%

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

Aguilera

Soothill²,

Denbow³

et al. 2009

Fetal Diagn Ther

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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.

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Audit of prenatal and postnatal diagnosis of isolated open spina bifida in three university hospitals in The Netherlands

Abstract: Objective To audit the current Dutch policy of prenatal detection of isolated open spina bifida based on offering detailed ultrasound examination only on indication. Methods

Cited by 22 publications

References 24 publications

Pregnancy termination following prenatal diagnosis of anencephaly or spina bifida: A systematic review of the literature

Pregnancy termination following prenatal diagnosis of anencephaly or spina bifida: A systematic review of the literature

Prenatal Diagnosis and Patient Preferences in Patients with Neural Tube Defects around the Advent of Fetal Surgery in Belgium and Holland

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

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