Cesarean section before the onset of labor and subsequent motor function in infants with meningomyelocele diagnosed antenatally

Da, Luthy; Wardinsky, Terrance D.; Db, Shurtleff; Hollenbach, KA; De, Hickok; Da, Nyberg; Tj, Benedetti

doi:10.1016/0020-7292(92)90516-l

Cited by 31 publications

(36 citation statements)

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“…However, other data 1,2,11,[13][14][15][16]18,22,26,27,33,34 and our experience attest to the ability of PVs to obtain optimum pressures nonoperatively in the outpatient department in the first 6 months of life as an indication for continued use. This current study does not address this short postoperative period.…”

Section: Discussionsupporting

confidence: 55%

Nonprogrammable and programmable cerebrospinal fluid shunt valves: a 5-year study

Hatlen¹,

Shurtleff²,

Loeser

et al. 2012

PED

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Object Programmable valves (PVs) for shunting CSF have increasingly replaced nonprogrammable valves (NPVs). There have been only a few longer-term studies (≥ 5 years) conducted that have compared the effectiveness of NPVs with that of PVs for children with hydrocephalus, and only 1 study has reported NPVs as being favorable over PVs. The objective of this retrospective study was to compare the long-term survival of these 2 types of shunt valves. Methods The authors collected data for all patients who underwent CSF shunt insertion or revision between January 1, 2000, and December 31, 2008. Patients underwent follow-up for a minimum of 2 years postoperatively. Statistical analyses were done using chi-square, Kaplan-Meier survival curve, and multivariate analyses. Results A total of 616 valves were implanted, of which 313 were PVs and 303 were NPVs. Of these, 253 were original shunt implantations and 363 were revisions. The proportion of 5-year survival for NPVs (45.8%) was significantly higher than that for PVs (19.8%) (p = 0.0005, log-rank). The NPVs that survived longer than 6 months also survived through the 5th year better than the PVs (p = 0.0001). Conclusions The authors' data suggest that NPVs survive longer than PVs in children, but there is a need for prospective, case-control studies to confirm these data.

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Section: Discussionsupporting

confidence: 55%

Nonprogrammable and programmable cerebrospinal fluid shunt valves: a 5-year study

Hatlen¹,

Shurtleff²,

Loeser

et al. 2012

PED

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“…Prenatal complications are rare and vaginal deliveries are often considered safe. 8 In general, perinatal morbidity and mortality are much lower in terminal myelocystocele than in SCT, though measured long-term outcomes are more variable.…”

Section: Discussionmentioning

confidence: 99%

Terminal Myelocystocele and Sacrococcygeal Teratoma: A Comparison of Fetal Ultrasound Presentation and Perinatal Risk

Yu¹,

Sohaey²,

Kennedy³

et al. 2007

American Journal of Neuroradiology

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SUMMARY:This case exemplifies the difficulty in differentiating cystic sacrococcygeal teratoma and terminal myelocystocele. Fetal sonography presentation and perinatal risks of sacrococcygeal teratoma and terminal myelocystocele are compared, and we emphasize the importance of obtaining fetal MR imaging to establish an accurate diagnosis.T he terminal spine presents unique imaging challenges, particularly in the case of large cystic masses. In the first case, an isolated terminal myelocystocele mimicked a cystic sacrococcygeal teratoma (SCT) on prenatal sonography. The second case of type 2 (SCT) is presented for comparison. We discuss the presentation and perinatal risks of these 2 cystic sacrococcygeal masses and illustrate surgical correction of a cystic terminal myelocystocele. Case Reports Index CaseA 22-year-old gravida 2, para 1 was referred to us for investigation of a fetal mass. Maternal serum alpha-fetoprotein (AFP) levels were mildly elevated, and amniocentesis results were a healthy female with normal acetylcholinesterase levels.At 30-weeks gestational age, sonography showed a cystic exophytic lower pelvic mass measuring 8 ϫ 7 ϫ 6 cm. The mass was skin-covered and septate ( Fig 1A, -B). It appeared to originate from the tip of an otherwise normal sacrum. Fetal calvaria views were normal, without Chiari II malformation. Amniotic fluid index (AFI) measured 21 cm, and fetal size was appropriate for gestational age. The size, location, and cystic composition of the mass and the perceived absence of skeletal dysraphism and Chiari II malformation supported the diagnosis of cystic SCT with complicating polyhydramnios. Fetal MR imaging was recommended to better characterize the mass; however, the patient refused due to claustrophobia. The follow-up fetal sonography at 36 weeks showed the mass had grown (10 ϫ 10 ϫ 6 cm) and the AFI had increased to 24 cm.At 37 weeks, the neonate was delivered via classic cesarean delivery without complications, weighing 3765 g with Apgar scores of 2, 5, and 8, at 1, 5, and 10 minutes, respectively. The mode of delivery was based on the prenatal diagnosis of a large SCT.Neonatal CT and MR imaging of the congenital cyst and spine revealed sacral spinal dysraphism and tethered cord (Fig 1C, -D). The diagnosis was revised to terminal myelocystocele.Surgical exploration was undertaken at 7 days of life ( Fig 1E, -F). The large cyst was entered and found to contain clear CSF in a terminal continuation of the spinal subarachnoid space. A second thinwalled cyst encountered at the base of the larger cyst represented terminal dilation of the spinal cord central canal (Fig 1G). These findings are diagnostic of terminal myelocystocele.1 Opening the second cyst revealed the true spinal canal, with lipomatous distal tethering of the cord to the dorsal and cranial aspect of the myelocystocele ( Fig 1H). Primary spinal cord untethering was undertaken, and the spinal canal was closed by using duraplasty material. Postoperatively, the neonate retained normal neurologic and urologic function....

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“…There were some observational studies dated back to 1990s suggesting that cesarean delivery may provide a better outcome for babies with MMC [25,26]. Proponents for routine cesarean delivery for fetal MMC believe that cesarean delivery may reduce bacterial contamination of the exposed neural tissue.…”

Section: Neural Tube Defectsmentioning

confidence: 99%

Delivery modes in case of fetal malformations

Wataganara

Grünebaum

Chervenak

et al. 2017

Journal of Perinatal Medicine

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An estimated 276,000 babies die within 4 weeks of birth every year, worldwide, from congenital anomalies. Better quality ultrasound screening can increase the detection of these fetal malformations in the prenatal period. Prenatal counseling for the pregnant woman and her family, regarding the nature of the disease and prognosis is necessary. Options for management in prenatal, perinatal, intrapartum, neonatal, and childhood periods need to be thoroughly discussed, so that the family can make an informed decision. A multidisciplinary approach is usually needed once a decision has been made to optimize fetal outcome, to plan for the timing and location as well as the mode of delivery. In most of the cases, vaginal delivery can be attempted. An elective cesarean delivery should be reserved for maternal concern of dystocia, certain fetal conditions that cesarean delivery will optimize perinatal outcome, or if the parents have a psychosocial determination to have a live-born infant.

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Cesarean section before the onset of labor and subsequent motor function in infants with meningomyelocele diagnosed antenatally

Cited by 31 publications

References 0 publications

Nonprogrammable and programmable cerebrospinal fluid shunt valves: a 5-year study

Nonprogrammable and programmable cerebrospinal fluid shunt valves: a 5-year study

Terminal Myelocystocele and Sacrococcygeal Teratoma: A Comparison of Fetal Ultrasound Presentation and Perinatal Risk

Delivery modes in case of fetal malformations

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