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Spina Bifida is one of the anomalies of the nervous system. It is potentially serious because there is a danger that the child will be left with enough neurologic disorders to affect total functioning.
Although the term spina bifida (Latin for "divided spine") is most often used as a collective term for spinal cord involvement, there are well defined degrees of spina bifida involvement. All of these disorders occur because of lack of fusion of the posterior surface of the embryo in early intrauterine life.
FOLIC ACID DEFICIENCIES
Studies have shown that insufficient levels of folic acid at the time of conception and during the embryonic stage of development may be a major contributor to neural tube disorders. Folic acid helps to regulate embryonic and fetal nerve cell formation, which is vital for the normal development. Women, before and during pregnancy, need to have a minimum daily intake of 400 micrograms to prevent the vast majority of neural tube defects such as spina bifida and anencephaly. To be effective, this regiment must be started before and continue for at least the first 3 months of pregnancy. If a woman waits until she is pregnant, it may be too late, because the critical events in fetal development occur during the first six weeks of pregnancy - before most women know they are even pregnant.
The incidence is 1 to 3 per 1000 live births. They may occur as a polygenic inheritance pattern. Women who have had one child born with such a defect have an increased chance of having a second child born with such a defect (as great as 1 in 20). For this reason, women who have had one child born with a spinal cord are advised to have a maternal serum assay or an amniocentesis done to determine if such a defect exists in a second pregnancy. This is revealed by the presence of alpha-fetoprotein (AFP) in the serum or amniotic fluid escaping from an open cord lesion. These assessments are done at the fifteenth week of pregnancy, when AFP reaches its peak concentration.
Alpha-fetoprotein screening detects neural tube defects such as anencephaly, microcephaly, hydrocephaly and spina bifida. Unfortunately the test has a 20 percent false positive rate, so that ultrasound may be necessary for final diagnosis. Numerous states require informing parents of the benefits and risks of alpha-fetoprotein screening.
C. & D. Portrays the outline of a normal skull and normal cerebellum.
TYPES OF SPINA BIFIDA
A. Normal spinal column
B. Spina bifida occulta
C. Meningocele
D. Myelomeningocele
A. Spina Bifida Occulta. Spina bifida occulta is a developmental anomaly in which posterior spinal vertebrae fail to close. This anomaly usually involves one or two vertebrae at the sacral or lumbar area, although it may occur at any place along the spinal column. The spot is evident as a depression in the skin. Often there is a tuft of hair growing at the place of the depression.
B. Meningocele. A meningocele is a pouching of the meninges and cerebrospinal fluid through a defect in the posterior surface of the spinal vertebrae. The meningocele may be covered by a layer of skin, or it may be denuded, with just the fibrous dura matter exposed.
C. Myelomeningocele. A myelomeningocele is a pouching of the spinal cord, the meninges and cerebrospinal fluid through a defect in the posterior spinal vertebrae. Often the spinal cord ends at the level of the myelomeningocele, and so there will be no motor or sensory function below this point. As this is lower motor neuron damage, the child will have flaccidity of the lower extremities and loss of bowel and bladder control. The infant's legs are lax; the baby does not move them, and urine and stools continually dribble because of lack of sphincter control. It is generally difficult to tell from the gross appearance of the myelomeningocele whether or not it is the simpler meningocele.
D. Encephalocele. An encephalocele is a myelomeningocele occurring at the back of the neck or head. The sac contains brain tissue, as well as spinal cord, meninges, and fluid.
RESOURCE LINKS
SpinaBifida Association of New Orleans
Spinabifida Association of America
March of Dimes
Lumps, Bumps & Holes
Washington State Genetics Documents
MoonDragon's ObGyn Procedures: Amniocentesis
Photos from Diagnosis in color Obstetrics and Gynecology by Symonds and Macpherson.
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