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Spina bifida – Definition, Types, Causes, Symptoms, Treatment and pictures by Miljan Krcobic |
August 21, 2017
What is Spina Bifida? Contents [hide] 1 What is Spina Bifida? 1.1 Different types of Spina Bifida 1.1.1 Myelomeningocele: 1.1.2 Meningocele: 1.1.3 Spina bifida occulta: 1.2 What is spina bifida occulta? 1.3 Spina Bifida meningocele 1.4 Spina Bifida Myelomeningocele or Spina Bida Cystica 1.5 Spina bifida with Myelocele 2 Why does Spina Bifida happen? 2.1 Spina Bifida causes 2.2 Spina Bifida prevalence 2.3 Physical signs and symptoms of Spina Bifida 2.4 Neurological symptoms of Spina Bifida 2.5 Spina Bifida and executive function 2.6 Spina Bifida and low academic skills 2.7 Spina Bifida complications 2.8 Spina Bifida pathophysiology 2.9 Family history and spina bifida 2.10 Drugs that may provoke spina bifida during pregnancy 2.11 Lack of folic acid during pregnancy and spina bifida 2.12 Spina Bifida diagnosis 2.13 Blood tests for Spina Bifida 2.14 Ultrasound for spina bifida diagnosis 2.15 Amniocentesis for spina bifida diagnosis 2.16 Spina bifida prevention 2.17 Spina bifida treatment 2.18 Surgery for Spina Bifida 2.19 Prenatal surgery for Spina Bifida 2.20 Ongoing care and Spina Bifida 2.21 Cesarean birth and Spina Bifida 2.22 Fetoscopic surgery for Spina bifida 2.23 Recommendations for women at higher risk of spina bifida
Spina bifida is defined as birth defects that are the deficiencies of the neural tube development. The neural tube is an embryonic structure that develops in the brain and spinal cord. The neural tube is formed in the first trimester of pregnancy and gets completed by the 28th day from the date of conception. In babies who are suffering from spina bifida, a part of the neural tube fails to close properly. Thus, it causes problems in the spinal cord and in the bones of spine. The level of severity varies from baby to baby. If possible, it is treated surgically. In most of the cases, surgery is not sufficient as it does not solve the problem.
Different types of Spina Bifida There are mainly three types of spina bifida that vary according to the malformation. These malformations occur in the hips or lower back. In Canada, approximately 260 babies are born every year with these defects. Spina bifida is the most common of them.
Myelomeningocele: It is the most serious form of neural tube defect. It affects both spinal cord and meninges or linings that protrude from an opening into the spine.
Meningocele: It affects the lining or meninges.
Spina bifida occulta: It is the mild form of neural tube defect. There occurs a breach in the spinal vertebrae.
What is spina bifida occulta? Occulta means hidden. This is a mild type of spina bifida. In this condition, the outer part of the vertebrae does not get completely closed. The splits in the vertebrae are very small that does not allow the spinal cord to protrude. The skin at the site might be normal, may have growing hair, dimple and birthmark. Unlike many other neural defects, spina bifida occulta does not have increased AFP. Increased AFP is used to detect NTD in uterus. In spina bifida occulta a dural lining is present. People don’t know that they are suffering from Spina Bifida as it is asymptomatic. There are approximately 10–20% of incidences of spina bifida occulta. A review of radiographic studies showed no relationship between back pain and spina bifida occulta. Studies also shown that this defect is harmful. Studies have also showed that patients suffering from back pain can have spina bifida occulta that can be very serious.
Spina Bifida meningocele A posterior meningeal cyst is the least form of spina bifida. The single defect allows the meninges to herniate in between the vertebrae. The nervous system does not get damaged. The patients who have meningocele do not suffer from any long-term health problems. The cases of the tethered cord are reported. The reasons of meningocele are teratoma, Currarino syndrome, a tumor of sacrococcyx and presacral space. It can also be caused by dehiscence at the base of the skull and are classified by the localization. They can be located at occipital, nasal and frontoethmoidal. Endonasal meningoceles are located at the top position of the nasal cavity and can be mistaken as a nasal polyp. This condition can be treated surgically. Encephalo- meningoceles come under the same category of Spina Bifida meningocele.
Spina Bifida Myelomeningocele or Spina Bida Cystica Myelomeningocele, also known as meningomyelocele, is the type of spina bifida that often results in the most severe complications. In individuals with myelomeningocele, the unfused portion of the spinal column allows the spinal cord to protrude through an opening. The meningeal membranes that cover the spinal cord also protrude through the opening, forming a sac enclosing the spinal elements, such as meninges, cerebrospinal fluid, and parts of the spinal cord and nerve roots.
Spina bifida with Myelocele This condition is the most severe form of myelomeningocele. In this type of defect, the area has a flattened mass of nervous tissue. It does not have any membrane. The exposure of tissues and nerves can result in life-threatening infections in the baby. The baby can develop an infection like meningitis. In this defect, the protruding part of nerves and spinal cord that are originated are damaged or are not developed properly. The baby suffering from this defect can develop paralysis and loss of sensation. The paralysis can occur below the spinal cord. The cranial level of the defect is directly proportional to the severity of the associated nerve dysfunction. It can result in paralysis. The baby can develop the symptoms like ambulatory problems, deformities of the hip, knees or feet, loss of sensation and muscle tone.
Why does Spina Bifida happen? Presently the cause of this disease is not known. The research is being continued. However, we are well aware that folic acid reduces the risk of spina bifida in unborn babies. So, every pregnant woman must take folic acid. Even the family who is not having the history of spina bifida, the pregnant women must take 400 mcg of folic acid on the daily basis. Where there is a history of spina bifida, a pregnant women must take a dose of 5mg of folic acid. Folic acid must be taken on the daily basis for at least thirty days prior to conception. It must be continued until the 12th week of pregnancy. Even if you are taking folic acid rich diet, then also folic acid as a supplementary tablet is needed. The reasons why the neural tube defects develop in an unborn child is still not known. It is speculated that it might be connected with both genetic and environmental factors.
Spina Bifida causes The exact reason of spina bifida is not unknown. If something goes wrong during the first 2 months after conception, doctors do not know its reason. It’s been known by the experience that the women having low levels of folic acid give birth to baby with neural tube defects. It’s been assumed that genes of the fetus are responsible to construct spine. The chemicals that help in the formation of the spinal cord are missing. Women who have a family history of NTDs are at the risk of giving birth to a baby having neural tube defect. The parents who already have one child with spina bifida are at a higher risk of having another baby with NTDs. Many of the cases of spina bifida occur in families with no history associated with this condition. Other risk factors in a child having spina bifida include uncontrolled diabetes and obesity.
Spina Bifida prevalence Many epidemiological studies consider spina bifida together with anencephaly or encephalocele, under the term ‘neural tube defects’ (NTDs). The prevalence of NTDs is varied over the past many decades. It showed differences in the geographical locations. It is been reported that NTDs in the USA and many other European countries is 0.5-0.8/1000 births. In some location of China, it has been reported to be more than 20 times higher. We are assuming the prevalence of one NTD case per 1000 births. The global population of 7 billion have the birth rate of 20 per 1000 population. It results in the 140,000 NTD cases every year worldwide. The regions with higher NTD rate have shown higher frequencies of rarer subtypes. These are craniorachischisis and anencephaly. Within the country, many differences are seen between racial and ethnic groups. In the USA, Hispanics have a higher rate of spina bifida. African-Americans have lower rate of NTDs as compared with non-Hispanic whites. The prevalence of differences in time and geographic regions are the combined factors of variations and risk. The prevalence of NTDs is very challenging. The diagnosis is based on antenatal screening procedures. It can lead to diagnosis and termination of pregnancy. EUROCAT, the European network of population-based registries for epidemiological surveillance of congenital anomalies, collects data on the termination of pregnancies. In addition to it, it also records the number of live and stillbirths. It generates comprehensive data on NTDs and other malformations. In 2003 to 2007, EUROCAT estimated 0.51 cases of spina bifida and 0.94 cases of NTDs per 1000 births including still birth and pregnancy termination.
Physical signs and symptoms of Spina Bifida Signs of spina bifida are as follows: Paralysis and weakness of legs Orthopedic abnormalities like hip dislocation, club foot and scoliosis Bladder and bowel problems that includes incontinence UTI , and poor kidney function Skin irritations and pressure sores Abnormal eye movement 68% of children who are suffering from spina bifida develop an allergy to latex. It can lead to life-threatening conditions. The use of latex makes a serious concern in the medical field. The use of latex-containing products must be avoided. The products like gloves, condoms and catheters are not free from latex. There are many other products that are used by dentists that contains latex. The lesion in the spinal cord or scarring because of surgery can result in the tethered spinal cord. It can result in traction and stress on the spinal cord. It further leads to the worsening of paralysis, back pain, scoliosis, and worsening of bowel or bladder function.
Neurological symptoms of Spina Bifida The individuals with spina bifida have an abnormality of the cerebellum that is called Arnold Chiari II malformation. The individual who is suffering from this defect, the brain’s back portion gets displaced from the back of the skull down to the upper neck. In 90% of the people suffering from myelomeningocele, develops hydrocephalus. The displaced cerebellum interferes with the flow of cerebrospinal fluid that causes the fluid to accumulate. In fact, the cerebellum is smaller in individuals with spina bifida. It is true for the individuals who have higher lesion levels. In 70-90 % of individuals, corpus callosum is developed abnormally. It happens in the individuals with spina bifida myelomeningocele. This affects the process of communication between the right and left brain hemispheres. The white matter tracts that connect posterior brain regions with anterior regions are less developed. White matter tracts in between frontal regions is also found to be impaired. The abnormality in Cortex may also be present. The frontal regions of the brain can be thicker while posterior and parietal regions are thinner. Brain’s thinner sections are associated with increased cortical folding. The neurons in the cortex are displaced.
Spina Bifida and executive function Several studies have shown that the children who are suffering from executive functions with spina bifida are observed with shunted hydrocephalus. The children with the problem of spina bifida are not able to improve their executive functioning as their age increases. Some areas of difficulty are organizing, planning, initiating, and working memory. They can also face the problems like abstraction, problem-solving, and visual planning. Children suffering from spina bifida might have poor cognitive flexibility. Executive functions are attributed to brain frontal lobes. Individuals with spina bifida have intact frontal lobes. Therefore, it affects another part of the brain. The individuals that are suffering from spina bifida, especially those suffering from shunted hydrocephalus, often face serious attention problems. Children with spina bifida and shunted hydrocephalus have higher chances of ADHD than children without those conditions. The ratio can be 31% vs. 17%. Many other symptoms are observed like problem in selective attention and focused attention. Poor motor speed contributes to poor scores on the tests of attention. We can detect the attention deficits at a very early age. The infants with spina bifida lag behind their peers.
Spina Bifida and low academic skills The individuals who are suffering from spina bifida might struggle academically, preferably in mathematics and reading. In a study, 60% of children suffering from spina bifida were diagnosed with the disability in learning. The abnormalities in the brain are directly linked to various problems in academic skills. The achievement is affected by the impaired attention and executive functioning. Children with spina bifida may perform in elementary school. As they grow, struggles with increased academic demands that they are not able to cope with. Children suffering from spina bifida have more probability to be dyscalculic in comparison with their peers without spina bifida. The individuals with spina bifida have shown difficulties in arithmetic accuracy and speed. They also face problems in solving mathematical and understanding of numbers in everyday life. Mathematics difficulties are directly linked to thinning of parietal lobes. Parietal lobes are the regions that implicates mathematical functioning. Parietal lobes are also indirectly responsible for deformities in the cerebellum and midbrain. These deformities affect other functions involved in mathematical skills. The higher numbers of shunt revisions are responsible for poor mathematics abilities. It also affects the working memory and inhibitory control deficiencies that are responsible for difficulties in math. It does not involve visual-spatial difficulties. The early intervention is necessary for addressing mathematics difficulties and executive functions. The individuals with spina bifida have better reading skills than mathematics skills. Children and adults with this ailment have strong abilities in reading accuracy than reading comprehension. Comprehension is impaired for text that requires an abstract synthesis of information rather than literal understanding. People with spina bifida have difficulty in writing due to deficiency of motor control and memory.
Spina Bifida complications Many people with spina bifida suffer from paralysis usually in the lower portion of body. You may need wheelchairs or other supporting aids. The severity of the paralysis depends on the location and severity of the lesion in the spine. Some people with mild spina bifida Occulta don’t experience any physical problems. The paralysis is very common and begins in the womb only. Babies might have already suffered from complications of paralysis at the time of birth. The baby can have a spine that’s too curved at the base. It prevents an infant from lying normally on the back. Sometimes the bones of the spine (vertebrae) or other joints become locked in position, typically in a bent position. Clubfoot and dislocated hips are other malformations that can be seen at the time of birth. The nerves controlling the bowel and bladder are often found to be damaged in spina bifida. It can lead to various problems like severe constipation and frequent infections. It can put a huge strain on the kidneys that can lead to kidney failure and death. Most people suffering from spina bifida have malformations in the spinal cord or brain. It leads to a dangerous accumulation of cerebrospinal fluid (CSF) inside the ventricles in the brain. This state is called hydrocephalus. A large portion of people with spina bifida develops this condition. It can cause the skull to grow out of proportion in the infants suffering from spina bifida. This condition can be treated. Individuals suffering from spina bifida has normal level of intelligence but for unknown reasons they develop the learning disabilities like dyslexia, difficulty in paying attention, and problems in learning math.
Babies that are born with meningocele are at risk of developing meningitis. It is an infection of the lining of the brain and spinal cord. Newborns with these types of spina bifida problem undergo surgery. In the surgical procedure their spinal lesion is closed in the first few days after birth. But there’s no way to repair the damaged nerve tissue. The attempts that were done to intervene and prevent damage before birth are not successful.
Spina Bifida pathophysiology Sometimes spina bifida is caused by the failure of the neural tube to close during the first month of embryonic development. Many times the mother does not know that she is pregnant. Some forms of spina bifida occur with primary conditions that are caused due to increased central nervous system pressure. The raised CNS pressure raises the possibility of a dual pathogenesis. In normal conditions, the closure of the neural tube occurs in the 23rd day that is rostral closure and 27th day that is caudal closure after fertilization. However, if something interferes and tube fails to close completely then a neural tube defect occurs. The medications like anticonvulsants, obesity, and diabetes having spina bifida affect the probability of neural tube malformation. There is an extensive evidence from mouse strains suffering from spina bifida that indicates there is a genetic basis for the condition. Human spina bifida occurs from the interaction of multiple genes. It occurs like any other human diseases such as cancer and atherosclerosis results from the interaction of multiple genes and environmental factors. The research has shown that the lack of folic acid is a major contributing factor in the pathogenesis of neural tube defects that includes spina bifida. The mother’s diet must include folate. It can reduce the incidence of neural tube defects by about 70%. It also decreases the severity of these defects. It is unknown how or why but folic acid has this effect. Spina bifida does not directly cause direct heredity problems like muscular dystrophy or hemophilia. Studies have shown that woman having one child with a neural tube defect like spina bifida has about 3% risk of having another child suffering from spina bifida. This risk can be reduced with the supplementation of folic acid before pregnancy. Normally, low dose of folic acid is advised that is 0.4 mg/day.
Family history and spina bifida If you have a family member with a neural tube defect like spina bifida, then it can increase your chances of having a baby with spina bifida. If you had a child with spina bifida, your chance of having other children with the same condition gets increased. If you have a family history of spina bifida, it is very important that you must take folic acid, prescribed by your doctor. He will give you folic acid before you become pregnant or for at least the first 12 weeks of pregnancy.
Drugs that may provoke spina bifida during pregnancy Taking some medicines during pregnancy is linked to the increase in the risk of having a baby with spina bifida or other birth defects. Valproate and carbamazepine are medications that are directly linked to spina bifida. They are used for the treatment of epilepsy, and mental conditions like bipolar disorder. There are currently no good alternatives to these treatments of organic illness, so a pregnant woman must make a decision on whether to discontinue use of these medications during the first trimester based on risks and benefits. Medications that are routinely used to treat depression such as selective serotonin reuptake inhibitors (SSRIs) are known to increase the risk of neural tube defects in fetuses if taken in the first trimester. The mechanism of this risk is not currently known. Scientists are closing in on particular gene groups that seem to be responsible for spina bifida. In specific, there are various genes that are involved in folate metabolism that seem to be linked to this defect. Oddly, another set of genes that are involved in glucose metabolism are also linked to neural tube defects. Hopefully a full picture of what is happening in these developmental defects is forthcoming. Doctors try to avoid administering these medicines if you are trying to get pregnant while taking them. But they are needed if the alternatives aren’t effective.It’s advisable to use a good quality contraceptives if you are taking these medicines and aren’t trying to get pregnant.Consult your doctor if you are thinking to try for a baby and taking one of these medicines. It is required to lower the dose. Doctor’s must prescribe folic acid supplements at a higher than normal dose to reduce the risk of the problems. If you are not sure that medicines will affect your pregnancy, then check with your doctor before taking it. Don’t stop taking medicines unless healthcare professional advises you for the same.
Lack of folic acid during pregnancy and spina bifida If you don’t have enough folic acid during pregnancy then it increases your chances of having a child suffering from spina bifida. Folic acid is found in some foods like broccoli, peas and brown rice. It is added to foods like breakfast cereals. Folic acid tablets are available on pharmacies & supermarkets. Your doctor prescribes folic acid to you. It is estimated that if you take folic acid supplements before conceiving or while you’re pregnant. It may prevent up to 7 out of 10 cases of neural tube defects like spina bifida. It’s still not clear how folic acid helps to prevent spina bifida. Folic acid is very important for biochemical reactions in the body.
Spina Bifida diagnosis Spina bifida can be diagnosed very easily at birth. Myelomeningocele and meningocele are clearly visible. Spina bifida Occulta is diagnosed by a tuft of hair or dimple at the lower end of the spine. This can be confirmed with an ultrasound or MRI. It will reveal the location and size of any spinal lesions.
Blood tests for Spina Bifida Your doctor will most likely check for spina bifida by first performing the following: Maternal serum alpha-fetoprotein (MSAFP) test.A test is used to check myelomeningocele. It is the maternal serum alphafetoprotein (MSAFP) test. Your doctor draws a blood sample and sends it to a laboratory. It is tested for alpha-fetoprotein (AFP) — a protein that’s produced by the baby. It’s normal that a small amount of AFP crosses the placenta and enter the mother’s bloodstream. The abnormally high levels of AFP suggest that the baby has a neural tube defect more commonly spina bifida or anencephaly. This is a condition that is characterized by an underdeveloped brain and an incomplete skull. Some cases of spina bifida don’t produce a high level of AFP. On the other hand, when a high level of AFP is found, a neural tube defect is present only in small proportion. The varying levels of AFP can be caused by other factors like miscalculation in fetal age or multiple babies. Your doctor can order a follow-up blood test for confirmation. If the results are high, an ultrasound examination is required. Other blood tests.Your doctor can ask to perform MSAFP test with two or three blood tests, which may detect other hormones, like HCG, inhibin A and estriol. Depending on the number of tests, this combination is called a triple screen or quadruple screen. These tests are done with the MSAFP test. Their objective is to screen for trisomy 21 (Down syndrome) not neural tube defects.
Ultrasound for spina bifida diagnosis Many obstetricians choose ultrasonography for screening spina bifida. If blood tests indicate high AFP levels, doctor will prescribe an ultrasound to help determine the reason. The most common ultrasound exams bounce high-frequency sound waves off tissues in your body. It forms black-and white images on a video monitor. These images provide the information whether there’s more than one baby and can help confirm gestational age. These are the two factors that can affect AFP levels. An ultrasound can detect signs of spina bifida like open spine or particular features in your baby’s brain that indicate spina bifida. Ultrasound is quite effective in detecting spina bifida and its severity. Ultrasound is safe for baby and mother.
Amniocentesis for spina bifida diagnosis If a blood test shows high levels of AFP in the blood but the ultrasound is normal, then your doctor may offer amniocentesis. During amniocentesis doctor uses a needle to remove a sample of fluid from the amniotic sac surrounding the baby. Analysis indicates the level of AFP that is present in the amniotic fluid. Some amount of AFP is normally found in amniotic fluid. If an open neural tube defect is present, the amniotic fluid contains an increased level of AFP because skin surrounding baby’s spine is gone. The AFP leaks into the amniotic sac. You can discuss the risks of this test that includes a slight risk of loss of the pregnancy with your doctor.
Spina bifida prevention There is neither a single cause of spina bifida nor any way to prevent it. Dietary supplementation with folic acid is shown to be helpful in reducing the incidence of spina bifida. The sources of folic acid are whole grains, breakfast cereals, beans, green leafy vegetables and fruits. The Folate fortification of enriched grain products is mandatory in the U.S. The USFDA, Public Health Agency of Canada and UK recommended amount of folic acid. This quantity of folic acid is recommended for women of childbearing age. It is also important for women who are planning to become pregnant. The dose is at least 0.4 mg/day of folic acid from at least 3 months before conception. It must be continued for the first 12 weeks of pregnancy. The women who have already had a baby with spina bifida or a neural tube defect or are taking anticonvulsant medication, must take a higher dose of 4–5 mg/day. Certain mutations in the gene VANGL1 are linked with spina bifida in the families with a history of this condition. Environment, chemical and pharmaceutical risks for Spina Bifida Environmental, chemical and pharmaceutical concerns are typically preventable. In general, one should stay away from toxins that are known to be detrimental to the development to the fetus. Thalidomide was a huge problem a few decades ago. It was prescribed to women as a safe sedative, even during pregnancy until a rash of birth defects, including spina bifida, resulted in women who routinely took the drug. It is also used to treat multiple myeloma. These days, thalidomide is a drug of last resort and is never prescribed for pregnant women.
Spina bifida treatment The treatment of spina bifida depends on the severity of the condition. Spina bifida Occulta often doesn’t require treatment. Other types of spina bifida require treatment.
Surgery for Spina Bifida Meningocele requires surgery to put the meninges back in place and close the opening in the vertebrae. The surgery must be done within 24 – 48 hours after the birth. The early surgery minimizes the risk of infection that’s associated with the exposed nerves. It helps to protect the spinal cord from additional trauma. During the procedure, a neurosurgeon places the spinal cord. He places the exposed tissue inside the baby’s body and cover them with muscle & skin. Sometimes a shunt is placed that controls hydrocephalus in the baby’s brain. It is placed during the operation on the spinal cord.
Prenatal surgery for Spina Bifida Prenatal surgery takes place before the 26th week of pregnancy. Surgeons expose a pregnant mother’s uterus surgically. They open the uterus and repair baby’s spinal cord. It is believed that nerve function in babies suffering from spina bifida worsens rapidly after birth. It is better to repair spina bifida and defects while you’re pregnant and the baby is inside you. Till date, children who have received the fetal surgery need fewer shunts. They are less likely to require crutches or other walking devices. But the operation has the risk to the mother and a greater risk of premature delivery. You can discuss with your doctor whether this procedure is right for you or not.
Ongoing care and Spina Bifida Treatment doesn’t end with the initial surgery. In babies suffering from myelomeningocele, an irreparable nerve damage has already occurred. The care from a multidisciplinary team of surgeons, therapists and physician is required. Babies with myelomeningocele may need further operations as they can develop a variety of complications. The paralysis, bladder and bowel problems always remain. The treatment for these conditions begins soon after the birth. Babies with myelomeningocele must start with exercises that will prepare their legs for walking with the support of braces or crutches as they get older. Many of the babies have tethered spinal cord. This is a condition in which the spinal cord is bound to the scar of the closure. This progressive “tethering” causes the loss of muscle function to the legs, and bladder. Surgery limits the degree of disability. It can also restores some function.
Cesarean birth and Spina Bifida Cesarean birth can be the treatment for spina bifida. Many babies with myelomeningocele are in a breach position. If your baby is in this position or doctor has detected a large cyst, then cesarean birth is a safer way to deliver your baby.
Fetoscopic surgery for Spina bifida In the open fetal operative approach performed in the MOMS trial, a minimal invasive fetoscopic approach has been developed. This approach has been evaluated by independent authors of a controlled study. It showed some benefits in survivors. The observations in mothers and their fetuses that were operated in the last two and a half years through the minimally invasive approach have shown the following results. Compared with the open fetal surgery technique, fetoscopic repair of myelomeningocele results in less surgical trauma to the mother. The large incisions on her abdomen and uterus are not required. The initial punctures have a diameter of 1.2 mm only. The thinning of the uterine wall is among the most worrisome and criticized complications. The open operative approach is not required following minimally invasive fetoscopic closure of spina bifida aperta. The risk of fetal death as a result of the fetoscopic procedure run below 5%. Women are discharged one week after the procedure. The chronic administration of tocolytic agents are not required. The postoperative uterine contractions are barely observed. The current cost of the entire fetoscopic procedure is approximately €16,000. In 2012, these results of the fetoscopic approach were presented at national and international meetings. They were also presented at the 1st European Symposium “Fetal Surgery for Spina bifida” in April 2012 in Giessen. It was also appreciated at the15th Congress of the German Society for Prenatal Medicine and Obstetrics in May 2012 in Bonnn. It was also shown at the World Congress of the Fetal Medicine Foundation in June 2012. It was also presented at the World Congress of the International Society of Obstetrics and Gynecology in Copenhagen in September 2012.
Recommendations for women at higher risk of spina bifida Women at higher risk of having a child with spina bifida need to be given a higher 5- milligram dose of folic acid. Women at higher risk include Having a family history of babies suffering from neural tube defects Having partner with a family history of babies suffering from neural tube defects Had a previous pregnancy where baby suffered from a neural tube defect Diabetes If you are on medicines that treats epilepsy, you must consult your doctor. You may also need to take a higher dose of folic acid. “Impetigo in an Infant or a Baby: Condition, Treatments, and Pictures” “Mydriasis – Definition, Causes, Symptoms, Diagnosis, Constriction of pupil and Treatment”
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