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. 1992 Oct;61(2):127–133.

Neural tube defects--prenatal diagnosis and management.

R A Hamilton 1, J C Dornan 1
PMCID: PMC2448947  PMID: 1481301

Abstract

Neural tube defects rank second to congenital heart disease as a major cause of congenital malformation. Recent developments in ultrasound have improved prenatal diagnosis. Due to anomaly scans at 18 weeks gestation and the availability of a genetic clinic, prenatal diagnosis of neural tube defects at the Royal Maternity Hospital was 91.2% during 1987-1989. However, only 50% of parents accept termination of pregnancy and it is questionable if prenatal diagnosis is of benefit to those who wish to continue with the pregnancy. Parents may accept the situation better at birth, having had time to come to terms with it, helped with support from the obstetrician, clinical geneticist, paediatrician, genetic nurse and social worker. For some affected fetuses who have better muscle function and leg movement at term it appears from the literature that the outcome may be improved by caesarean section delivery. In Ireland fetuses with neural tube defects will continue to be delivered, as termination is unacceptable to many, but despite this there may be a positive benefit from prenatal diagnosis of neural tube defects. Prospective randomised controlled trials are needed to confirm benefit from delivery by caesarean section for fetuses with a good prognosis. As a result of prenatal diagnosis of a neural tube lesion the fetus should enjoy benefit in terms of physical morbidity, and the parents should benefit in terms of psychological morbidity.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bensen J. T., Dillard R. G., Burton B. K. Open spina bifida: does cesarean section delivery improve prognosis? Obstet Gynecol. 1988 Apr;71(4):532–534. [PubMed] [Google Scholar]
  2. Campbell S., Johnstone F. D., Holt E. M., May P. Anencephaly: early ultrasonic diagnosis and active management. Lancet. 1972 Dec 9;2(7789):1226–1227. doi: 10.1016/s0140-6736(72)92273-8. [DOI] [PubMed] [Google Scholar]
  3. Chervenak F. A., Farley M. A., Walters L., Hobbins J. C., Mahoney M. J. When is termination of pregnancy during the third trimester morally justifiable? N Engl J Med. 1984 Feb 23;310(8):501–504. doi: 10.1056/NEJM198402233100806. [DOI] [PubMed] [Google Scholar]
  4. Chervenak F. A., Goldberg J. D., Chiu T. H., Gilbert F., Berkowitz R. L. The importance of karyotype determination in a fetus with ventriculomegaly and spina bifida discovered during the third trimester. J Ultrasound Med. 1986 Jul;5(7):405–406. doi: 10.7863/jum.1986.5.7.405. [DOI] [PubMed] [Google Scholar]
  5. Clayton-Smith J., Farndon P. A., McKeown C., Donnai D. Examination of fetuses after induced abortion for fetal abnormality. BMJ. 1990 Feb 3;300(6720):295–297. doi: 10.1136/bmj.300.6720.295. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Lorber J., Ward A. M. Spina bifida--a vanishing nightmare? Arch Dis Child. 1985 Nov;60(11):1086–1091. doi: 10.1136/adc.60.11.1086. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Luthy D. A., Wardinsky T., Shurtleff D. B., Hollenbach K. A., Hickok D. E., Nyberg D. A., Benedetti T. J. Cesarean section before the onset of labor and subsequent motor function in infants with meningomyelocele diagnosed antenatally. N Engl J Med. 1991 Mar 7;324(10):662–666. doi: 10.1056/NEJM199103073241004. [DOI] [PubMed] [Google Scholar]
  8. Nicolaides K. H., Campbell S., Gabbe S. G., Guidetti R. Ultrasound screening for spina bifida: cranial and cerebellar signs. Lancet. 1986 Jul 12;2(8498):72–74. doi: 10.1016/s0140-6736(86)91610-7. [DOI] [PubMed] [Google Scholar]
  9. Roberts C. J., Hibbard B. M., Elder G. H., Evans K. T., Laurence K. M., Roberts A., Woodhead J. S., Robertson I. B., Hoole M. The efficacy of a serum screening service for neural-tube defects: the South Wales experience. Lancet. 1983 Jun 11;1(8337):1315–1318. doi: 10.1016/s0140-6736(83)92424-8. [DOI] [PubMed] [Google Scholar]
  10. Stark G., Drummond M. Spina bifida as an obstetric problem. Dev Med Child Neurol Suppl. 1970;22(Suppl):157+–157+. doi: 10.1111/j.1469-8749.1970.tb03020.x. [DOI] [PubMed] [Google Scholar]
  11. Windham G. C., Edmonds L. D. Current trends in the incidence of neural tube defects. Pediatrics. 1982 Sep;70(3):333–337. [PubMed] [Google Scholar]

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