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open_neural_tube_defect

Open neural tube defect

Open neural tube defects occur when the brain and/or spinal cord are exposed at birth through a defect in the skull or vertebra.

Examples

Anencephaly

Encephalocele

Hydranencephaly

Iniencephaly

Schizencephaly

Spina bifida.

In most foetuses with open neural tube defect, the end portion of cerebellum was below the Occipitum dens line (ODL) associated with different degrees of ventriculomegaly.

The proposed innovation aims to bring to the ultrasound the most likely anatomical parameters of evaluation in normal foetuses and in foetuses with spinal dysraphism 1).


Controversy exists regarding the optimal mode of delivery for fetuses with open neural tube defects.

To compare neurological outcomes among infants with open neural tube defects who underwent vaginal compared to caesarean delivery.

Electronic databases MEDLINE, EMBASE, Scopus, and Clinicaltrials.gov were searched from inception to November 2017.

Eligible studies included observational or randomised studies comparing vaginal and caesarean delivery in pregnancies with fetal open neural tube defects who did not undergo prenatal repair.

Two reviewers independently reviewed abstracts and full text articles. Outcomes were compared between vaginal and caesarean delivery and prelabour caesarean versus labour. The primary outcome was motor-anatomic level difference. Secondary outcomes included shunt requirement, sac disruption, meningitis, and ambulation at 2 years. Meta-analysis was performed and mean difference or odds ratios with 95% confidence interval calculated.

Of 201 abstracts identified in the primary search, 9 studies (672 women) met eligibility criteria. Comparing vaginal and caesarean delivery, there was no significant difference in motor-anatomic level difference (mean difference -0.10, 95% CI -0.58-0.38; I2 =57%). The vaginal delivery group was less likely to require a shunt or have sac disruption (OR 0.37, 95% CI 0.14-0.95 and OR 0.46, 95% CI 0.23-0.90, respectively). Comparisons by prelabour caesarean versus labour showed no significant difference in motor-anatomic level difference (OR 1.29, 95% CI -0.63-3.21) or ambulation at 2 years (OR 2.13, 95% CI 0.35-13.12).

Caesarean delivery was not associated with improved neurological outcomes among fetuses with open neural tube defects 2).

1)
de Sá Barreto EQ, Moron AF, Milani HJ, Hisaba WJ, Nardozza LM, Araujo Júnior E, Cavalheiro S. The occipitum-dens line: the purpose of a new ultrasonographic landmark in the evaluation of the relationship between the foetal posterior fossa structures and foramen magnum. Childs Nerv Syst. 2015 May;31(5):729-33. doi: 10.1007/s00381-015-2621-x. Epub 2015 Feb 21. PubMed PMID: 25700613.
2)
Tolcher MC, Shazly SA, Shamshirsaz AA, Whitehead WE, Espinoza J, Vidaeff AC, Belfort MA, Nassr AA. Neurological outcomes by mode of delivery for fetuses with open neural tube defects: A systematic review and meta-analysis. BJOG. 2018 Jun 20. doi: 10.1111/1471-0528.15342. [Epub ahead of print] PubMed PMID: 29924919.
open_neural_tube_defect.txt · Last modified: 2019/01/09 20:35 by administrador