Meningomyelocele: Management in utero and Post Natum

  1. Gregory Bock and
  2. Joan Marsh
  1. David B. Shurtleff1,
  2. David A. Luthy2,
  3. David A. Nyberg3,
  4. Thomas J. Benedetti4 and
  5. Laurence A. Mack5

Published Online: 28 SEP 2007

DOI: 10.1002/9780470514559.ch16

Ciba Foundation Symposium 181 - Neural Tube Defects

Ciba Foundation Symposium 181 - Neural Tube Defects

How to Cite

Shurtleff, D. B., Luthy, D. A., Nyberg, D. A., Benedetti, T. J. and Mack, L. A. (2007) Meningomyelocele: Management in utero and Post Natum, in Ciba Foundation Symposium 181 - Neural Tube Defects (eds G. Bock and J. Marsh), John Wiley & Sons, Ltd., Chichester, UK. doi: 10.1002/9780470514559.ch16

Author Information

  1. 1

    Birth Defects Clinic, Division of Congenital Defects, Department of Pediatrics, University of Washington, Seattle, WA 98105, USA

  2. 2

    Division of Perinatal Medicine, Swedish Medical Center, 747 Summit Avenue, Seattle, WA 98104, USA

  3. 3

    Department of Ultrasound, Swedish Medical Center, 747 Summit Avenue, Seattle, WA 98104, USA

  4. 4

    Department of Obstetrics & Gynecology, University of Washington, Seattle, WA 98195, USA

  5. 5

    Departments of Diagnostic Ultrasound and Radiology, University of Washington, Seattle, WA 98195, USA

Publication History

  1. Published Online: 28 SEP 2007

ISBN Information

Print ISBN: 9780471941729

Online ISBN: 9780470514559

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Keywords:

  • meningomyelocele;
  • amniotic membranes;
  • neonatal meningitis;
  • neurulation;
  • lipomas

Summary

We report a four year follow-up of 39 of 47 infants born after pre-labour Caesarean section and 68 of 79 born vaginally. Loss of motor function due to late complications was more frequent in the Caesarean section group (Fisher's Exact; P = 0.004). However, the means of the differences between the X-ray levels (measured as the last intact vertebral arch seen on standard anteroposterior roentgenograms of the spinal column) subtracted from the motor levels still favour Caesarean section (mean = 3.24; SD = 2.7) over vaginal delivery (mean = 1.2; SD = 2.7) (Student's t-test; P = 0.0003). The frequencies of other complications, death and neonatal meningitis, were not significantly different. Another 38 infants born by Caesarean section after labour were more paralysed (mean of X-ray and motor difference = 1.8, SD = 2.2) following rupture of amniotic membranes than those with intact amniotic membranes with or without labour (mean = 3.4; SD = 2.2) (Student's t-test; P = 0.0067). The differences between X-ray and motor levels for patients born by Caesarean section with intact amniotic membranes and without labour (mean = 3.6; SD = 2.4) were not significantly different from those with labour and intact amniotic membranes (mean = 2.89; SD = 1.5). The number of new cases of meningomyelocele presenting to our clinic has decreased from an average of 30 per year between 1970 and 1987 to 14 between 1988 and 1992.