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

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.

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

“…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).…”

Prenatal Determination of the Upper Lesion Level of Spina Bifida with Three-Dimensional Ultrasound

“…They found 67% correct matching, and the assigned lesion levels were all within two segments. Aguilera et al [1 ]also reported the results in a regionally grouped fashion of 74 cases that underwent 2D examination. Correct matching was observed in 61% of cases, and the remaining cases had lesion levels that were within two segments.…”

“…Information given during prenatal diagnosis will usually direct the families to decide upon medical abortion. In a retrospective analysis of fetuses with spina bifida diagnosed in the last 10 years, nearly 3/4 of families opted for medical abortion [1]. Bruner and Tulipan [2] stated that, contrary to general beliefs, the prognosis is not always catastrophic for these infants.…”

Quality of Life and Myelomeningocele: An Ethical and Evidence-Based Analysis of the Groningen Protocol

“…A more recent publication from the UK followed 74 cases of prenatally diagnosed spina bifida. Termination of pregnancy was elected in 72% of the cases [8]. …”

“…Prenatal selection as well as improved perinatal medical and surgical care have improved neurological outcome [8]. Recent published reports with long-term outcomes at several decades reveal that the clinical outcome for patients with MMC treated in a nonselective manner is extremely variable, ranging from severe cognitive and motor disability to near normal neurological status.…”