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Document Details :
Title: Echografische diagnose van foetale lumbosacrale spina bifida
Author(s): WITTERS I, COUMANS A, GYSELAERS W, FRIJNS JP
Journal: Tijdschrift voor Geneeskunde
Volume: 69 Issue: 9 Date: 2013
Echographic diagnosis of lumbosacralspina bifida
Neural tube defects have a birth incidence of 1/1,000, a figure influenced by geographical and ethnic differences, as well as the intake of folic acid. The screening for spina bifida by maternal alpha-fetoprotein (AFP) used to be common practice. Actually, the prenatal diagnosis of spina bifida is realized by an ultrasound at fourteen weeks of gestation. Recently, efforts have been made to make the diagnosis earlier in the first trimester evaluating the intracranial translucency, the biparietal diameter and the spine transvaginally, but this procedure remains challenging. The main consequences of spina bifida are limb paralysis (almost always in lesions above L2), hydrocephalus caused by a Chiari malformation type II, urine and bowel incontinence.
Only very recently, in utero surgery for selected cases of spina bifida has been introduced in the United States and also in Belgium, intending to improve the need for ventriculoperitoneal shunting and independent walking; still, this remains an invasive surgical procedure with maternal/fetal risks of uterine rupture and preterm prelabour rupture of membranes.