Spina bifida is a birth defect where
the bones in the vertebral column do not fully cover the spinal cord, the spine
and spinal cord do not form properly and also leaving it exposed. Spina bifida
are mainly classified into three types. Occurring
of myelomeningocele (MMC; open spins bifida) in around 1 per 1000 births
worldwide. In India Spina Bifida occurs in approximately 5-7 cases per 1000
births. Out of 4 million babies born in the United State each year, spina
bifida affects between 1,500 and 2,000 of them. In China each year 80,000 new
cases of spina bifida occurs.
DEFINITION
Spina bifida is a birth defect that occurs when the spine
and spinal cord don't form properly. Spina bifida also called split spine.
TYPES OF SPINA BIFIDA
The three most common types of spina bifida are:
01. Spina Bifida
Occulta
02.Meningeal
03. Myelomeningocele
01. Spina Bifida Occulta:
02. Meningocele:
Another type of spina bifida is
meningocele. With meningocele a sac of fluid comes through an opening in the
baby’s back. But, the spinal cord is not in this sac. There is usually little
or no nerve damage.
This type of spina bifida can cause
minor disabilities.
03. Myelomeningocele:
Myelomeningocele is the most serious
type of spina bifida. With this condition, a sac of fluid comes through an
opening in the baby’s back.
This type of spina bifida causes
moderate to severe disabilities, such as problems affecting how the person goes
to the bathroom, loss of feeling in the person’s legs or feet, and not being
able to move the legs.
SYMPTOMS OF SPINA BIFIDA
The myelomeningocele lesion can occur
at any level on the developing spine, but most are found in the lumbo-sacral
region. Depending on the lesion’s location, myelomeningocele may cause:
Ø Bladder and bowel problems (incontinence)
Ø Sexual dysfunction
Ø Weakness and loss of sensation below the defect
Ø Inability to move the lower legs (paralysis) and other cognitive
impairments
Ø Orthopaedic malformations such as club feet or problems of the
knees or hips And also Spina bifida appearance the main physical manifestations
include:
- ·
Weakness of
limbs.
- ·
Paralysis.
- ·
Orthopaedic
problems- scoliosis, clubfoot, hip dislocation.
- · Urinary
incontinence- Kidney dysfunctions, urinary tract infection, lack of bladder
control.
- ·
Bowel
incontinence.
- · Skin irritations and rashes.
- ·
Pressure
sores (ulcers)
- ·
Abnormal eye
movements.
- ·
Allergy to
latex.
CAUSES
The exact causes of Spina Bifida
remain a mystery. No one knows what disrupts complete closure of the neural
tube, causing this malformation to develop.
Scientists suspect the factors that
causes Spina Bifida are Multiple; Genetic, nutritional and environmental
factors are play a role.
PREVENTION
Since the causes of spina bifida are
unknown, it is difficult to prevent it, but folic acid and tests during
pregnancy can help.
If you are pregnant or could get
pregnant, use the following tips to help prevent your baby from having spina
bifida:
Ø Take 400 micrograms (mcg) of folic acid every day.
Ø If you have already had a pregnancy affected by spina bifida, you
may need to take a higher dose of folic acid before pregnancy and during early
pregnancy.
Ø Talk to your doctor or pharmacist about any prescription and
over-the-counter drugs, vitamins, and dietary or herbal supplements you are taking.
Ø If you have a medical condition―such as diabetes or obesity―be
sure it is under control before you become pregnant.
Ø Avoid overheating your body.
RISK FACTORS
Spina bifida is more common among
whites and Hispanics, and females are affected more often than males. Although
doctors and researchers don't know for sure why spina bifida occurs, they have identified
some risk factors:
Folate deficiency:
Folate (vitamin B-9) is important to the healthy development of a baby.
Folate is the natural form of vitamin B-9. The synthetic form, found in
supplements and fortified foods, is called folic acid.
Some medications: For
example, anti-seizure medications, such as valproic acid (Depakene), seem to
cause neural tube defects when taken during pregnancy, possibly because they
interfere with the body's ability to use folate and folic acid.
Diabetes: Women with diabetes who don't control their
blood sugar well have a higher risk of having a baby with spina bifida.
Obesity: Pre-pregnancy obesity is associated with an
increased risk of neural tube birth defects, including spina bifida.
Increased body temperature: Some evidence suggests that increased body
temperature (hyperthermia) in the early weeks of pregnancy may increase the
risk of spina bifida.
PATHOPHYSIOLOHY
Spina bifida occurs at the end
of the first month of pregnancy when the two sides of the embryo's spine fail
to join together, leaving an open area.
In some cases, the spinal cord or
other membranes may push through this opening in the back.
ETIOLOGY
The etiology of spina bifida are involved with that’s;
Ø Multifactorial
Ø Genetics High rate of familial inheritance
Ø Nutritional status Gestational diabetes Folic acid
(Vitamin B12), Vitamin A, cholesterol
Ø Socioeconomic status.
DIAGNOSIS
Three tests can check for spina bifida and
other birth defects while the baby is still in the womb:
Blood test: A sample of the mother’s blood is
tested to see if it has a certain protein the baby makes called AFP. If the
level of AFP is very high, it could mean the baby has spina bifida or another
neural tube defect.
Ultrasound: High-frequency sound waves bounce
off tissues in your body to make black-and-white pictures of the baby on a
computer monitor. If your baby has spina bifida, you may see an open spine or a
sac poking out of the spine.
Amniocentesis: If the blood test shows a high
level of AFP but the ultrasound looks normal, your doctor may recommend amniocentesis.
This is when your doctor uses a needle to take a small amount of fluid from the
amniotic sac around the baby. If there’s a high level of AFP in that fluid that
means the skin around the baby's sac is missing and AFP has leaked into the
amniotic sac.
TREATMENTS
Spina bifida treatment depends on the severity
of the condition. Spina bifida occulta often doesn't require treatment at all,
but other types of spina bifida do.
Surgery before birth:
Nerve function in babies
with spina bifida can worsen after birth if it's not treated. Prenatal surgery
for spina bifida (fetal surgery) takes place before the 26th week of pregnancy.
Surgeons expose a pregnant mother's uterus surgically, open the uterus and
repair the baby's spinal cord. Research suggests that children with spina
bifida who had fetal surgery may have reduced disability and be less likely to
need crutches or other walking devices. In addition, fetal surgery may reduce
the risk of hydrocephalus. Ask your doctor whether this procedure may be
appropriate for you. Discuss the risks, such as possible premature delivery and
other complications, and potential benefits for you and your baby.
Cesarean birth:
Many babies with
myelomeningocele tend to be in a feet-first (breech) position. If your baby is
in this position or if your doctor has detected a large cyst or sac, cesarean
birth may be a safer way to deliver your baby.
Surgery after birth:
Meningocele involves surgery to put the
meninges back in place and close the opening in the vertebrae. Because the
spinal cord develops normally in babies with meningeal, these membranes often
can be removed by surgery with little or no damage to nerve pathways.
During the procedure, a
neurosurgeon places the spinal cord and exposed tissue inside the baby's body
and covers them with muscle and skin. Sometimes a shunt to control
hydrocephalus in the baby's brain is placed during the operation on the spinal cord.
Treatment for
complications:
In babies with myelomeningocele, irreparable
nerve damage has likely already occurred and ongoing care from a multispecialty
team of surgeons, physicians and therapists is usually needed. Babies with
myelomeningocele may need more surgery for a variety of complications.
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