Outcome of Fetal Spina Bifida

Overview

Neural tube defects are one of the most prevalent congenital abnormalities, surpassed only by cardiac malformations. Spina bifida accounts for the majority of the neural tube defects and is comprised of a wide spectrum of anomalies ranging from small isolated sacral dysraphisms to large spinal defects. The origin of spina bifida is a failure of neurulation. It usually occurs at 15 days post-conception, resulting in a bony spinal defect with extrusion of the neural placode and/or the meninges outside of the spinal canal. Spina bifida has a prevalence of 1-5 in 1,000 live births and is the most complex congenital abnormality compatible to long-time survival. Concerning psychomotor development as well as urinary bladder and intestinal morbidity the prognosis ranges from normal functional outcome to severe disability.

The diagnosis of serious fetal abnormalities such as spinal dysraphism by ultrasound screening allows patients to prepare for the birth of an impaired child or to consider termination of the pregnancy. In current practice, prenatal counseling and obstetric management depend not only on the detection of a spinal dysraphism but also on an appropriate assessment of the severity of the defect and its possible impact on the postnatal development of the affected child.

Level and type of lesion, presence of associated anomalies (e.g., Chiari II malformation and ventriculomegaly) and mode of surgical closure are factors known to have prognostic impact on the postnatal outcome. Previous studies reported that postnatally determined lesion levels correlated well with functional status and survival. On the contrary, it is still not clear whether similar data obtained antenatally are of value.

In this study, the investigators will review their database of all cases of prenatally diagnosed spina bifida within a 16 year period between 1993 and 2009. By analyzing the prenatal and postnatal characteristics of fetuses with spina bifida in relation to the anatomic level of the lesion, the investigators aim to contribute further information regarding the natural course of affected pregnancies and the correlation of prenatal ultrasound findings with their functional outcome.

Full Title of Study: “Fetal Spina Bifida -Prenatal Course and Outcome in 103 Cases A Single Center Experience.”

Study Type

  • Study Type: Observational
  • Study Design
    • Time Perspective: Retrospective
  • Study Primary Completion Date: October 2014

Arms, Groups and Cohorts

  • thoracal lesion
    • spinal lesion at thoracal level detected at prenatal ultrasound exam
  • lumbar lesion
    • spinal lesion at lumbar level detected at prenatal ultrasound exam
  • sacral lesion
    • spinal lesion at sacral level detected at prenatal ultrasound exam

Clinical Trial Outcome Measures

Primary Measures

  • pregnancy outcome
    • Time Frame: 17 yrs
    • To investigate the prenatal course and functional outcome of fetuses with spina bifida according to prenatal ultrasound exam.
  • Infant psychomotor development
    • Time Frame: 17 yrs
    • Kaufmann ABC Denver Developmental Screening Test walking ability muscle strenght
  • Infant bladder and bowel function
    • Time Frame: 17 yrs
    • Degree of continence.

Secondary Measures

  • Conception date
    • Time Frame: 17 yrs
  • spectrum of ultrasound signs
    • Time Frame: 17yrs

Participating in This Clinical Trial

Inclusion Criteria

  • spina bifida identified at prenatal ultrasound examination
  • ultrasound diagnosis between 1993 – 2009

Exclusion Criteria

  • deviant postnatal diagnosis
  • loss to follow-up
  • incomplete data

Gender Eligibility: All

Minimum Age: 12 Weeks

Maximum Age: 12 Years

Are Healthy Volunteers Accepted: No

Investigator Details

  • Lead Sponsor
    • University of Luebeck
  • Provider of Information About this Clinical Study
    • Principal Investigator: Daniel Alexander Beyer, Dr. D. A. Beyer – University of Luebeck
  • Overall Official(s)
    • Feriel Amari, M.D., Principal Investigator, Schleswig- Holstein University, Lübeck
    • Jan Weichert, M.D., Study Director, Schleswig- Holstein University, Lübeck
    • Klaus Diedrich, PhD, Study Chair, Schleswig- Holstein University, Lübeck

References

Cameron M, Moran P. Prenatal screening and diagnosis of neural tube defects. Prenat Diagn. 2009 Apr;29(4):402-11. doi: 10.1002/pd.2250. Review.

D'Addario V, Rossi AC, Pinto V, Pintucci A, Di Cagno L. Comparison of six sonographic signs in the prenatal diagnosis of spina bifida. J Perinat Med. 2008;36(4):330-4. doi: 10.1515/JPM.2008.052.

Biggio JR Jr, Owen J, Wenstrom KD, Oakes WJ. Can prenatal ultrasound findings predict ambulatory status in fetuses with open spina bifida? Am J Obstet Gynecol. 2001 Nov;185(5):1016-20.

Peralta CF, Bunduki V, Plese JP, Figueiredo EG, Miguelez J, Zugaib M. Association between prenatal sonographic findings and post-natal outcomes in 30 cases of isolated spina bifida aperta. Prenat Diagn. 2003 Apr;23(4):311-4.

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