Fetal Spina Bifida: Comprehensive Guide on Diagnosis, Treatment & Surgery

Spina bifida is a
birth defect that occurs when the spinal cord
fails to form properly, leaving a section of the spinal
cord and spinal nerves exposed through an opening in
the unborn baby’s back. There are several scientific
names for spina bifida. It is also known
as myelomeningocele or meningomyeocele. Although there are many
theories about why this happens, the exact cause of
spina bifida is unknown. However, we do know
that spina bifida a occurs early in pregnancy
during the development of the spinal cord,
typically about 35 to 42 days since your last
menstrual period or LMP. This rare condition
is reported to occur in one out of every 1,500 to
2,000 births in the United States every year. To better understand
the problems associated with spina bifida, let’s first
review the normal development of the spinal cord. In early fetal life, the tissue
that covers the spinal cord closes like a zipper. This typically begins in the
middle of the spinal cord and closes in both
directions, toward the head and toward the bottom
of the unborn baby. This process starts at about
35 days into fetal life. At 36 days since your
last menstrual period, there is almost complete
closure of the spinal cord, with only small openings
near the head and bottom. By 42 days since your
last menstrual period, there should be complete closure
of the spinal cord, also known as the neural tube. However, failure of the neural
tube to completely close will result in a
neural tube defect. If the tissue fails to
close near the fetus’s head, a condition known as
anencephaly can occur. Failure of the tissue to close
at the bottom end of the fetus results in a myelomeningocele,
or spina bifida. Here you can see the
differences in development of a normal fetus in
comparison to a fetus with an open neural tube defect
at the bottom of the fetus, an example of spina bifida. Several variations of
spina bifida can occur. These variations depend
on how the neural tube defect continues
to develop, on what is protruding through
the open neural tube, and what is covering the
spina bifida abnormality. These variations include spina
bifida occulta, or hidden spina bifida. This is a covered neural tube
defect where a layer of skin covers the opening in the spine. This form of spina bifida
occurs in approximately 15% of patients and rarely causes
any neurological problems. Myeloschesis is this
is a flat neutral tube defect without a
layer of skin covering the opening in the spine. The spinal cord and the
surrounding nerve tissue are exposed to the
amniotic fluid. These forms of spina bifida
have similar risks and symptoms as myelomeningoceles. Meningocele contains
only spinal fluid that sticks out through
an outpouching or sac through an abnormal
opening in the spine. This abnormality does not
contain any nerve tissues. Babies with meningocele
have few or no symptoms, while others may develop
degrees of paralysis with bladder and
bowel dysfunction. myelomeningocele is
the most severe form of a neural tube defect. It contains both fluid and
nerve tissue within a sac. This occurs when the spinal
cord or neural elements are exposed through the
opening in the spine, which results in nerve damage with
partial or complete paralysis of the body below the level
of the spinal opening. Individuals may
be unable to walk and may have bladder
and bowel dysfunction. Both meningoceles
and myelomeningoceles have a covering of skin with or
without an outpouching, known as covered neural tube defect. These conditions typically
have very mild to no symptoms. During the end of
the second trimester, you can see the opening of the
spinal cord and spina bifida defect developing. The image on the left
is a view from the side. As you can see,
there is an opening in the spinal cord that allows
an outpouching of tissue. This is myelomeningocele. The image on the right
demonstrates an outpouching from the defect as you look
down on the fetus’s back. The spinal column is
divided into four sections. Each segment of the
spinal cord corresponds with a specific region
of sensory, or sensation, and motor, or movement,
function in the body. Starting from the head, there
are seven cervical vertebrae found in the neck. Spinal nerves at this level
supply movement and feeling to the arms, neck, and
upper trunk of the body. Next are 12 thoracic
vertebrae associated with the chest, followed by
five lumbar vertebrae found in the lower back,
and six sacral vertebrae that
fuse at the bottom to form the tailbone or coccyx. In the normal spine
and spinal cord, nerves leave the
spinal cord and are numbered according to the
vertebrae at which they exit the spinal column. Their function is linked
to the level at which they leave the spinal cord. The location of
spina bifida defect can result in abnormal function. A spina bifida defect
is defined based on the level and extent
of the bony opening along the spinal canal. The level of bony
defect can help us predict the nerve damage
that a child may experience. The level of the
nerve damage may result in loss of sensation or
problems with motor function, including bowel, bladder,
and sexual dysfunction. Since most spina bifida defects
are associated with the lumbar spine, which is
responsible for the nerve function in the
legs and lower body we will focus on
consequences associated with these types of defects. In general, the nerves
associated with L1 to S1 are associated with movement
and sensation of the lower legs. Nerves associated
with L1 to L3 are responsible for
flexing the knee, whereas nerves
associated with L4 to L5 allow the knee to extend. At the same time, all
the nerves from L1 to L5 are required to provide
nerve function to the thighs and hips. The motor function
of the foot and ankle are controlled by
the lower nerves. However, all of the nerves in
the lumbar and sacral spine are needed to
properly coordinate movement of the hips, legs,
and feet in order to walk. Spinal levels L4 and L5
allow one to raise the foot. Spinal levels S1 and S2
allow one to lower the foot. In general, when
the spina bifida involves a level above L3,
the ability to walk normally is significantly impaired. In addition to the movement
of the lower extremities, nerves in the lumbar
and sacral regions help control functions
of the internal organs. Since many cases of
spine of spina bifida involve the sacral nerves,
children with spina bifida often have problems with
urination and bowel control. In later life, sexual
function may also be affected. Typically, children
with bladder problems are unable to completely
empty the bladder. Problems with bowel control
may result in soiling. Patients with spina
bifida may experience some sexual dysfunction,
but this may not affect their reproductive ability. The exact mechanism by which
the spina bifida defect causes nerve damage is unclear. There are several theories,
but the most popular one is a two-hit approach. The first hit is the
failure of the spinal column to properly close, resulting in
the exposure of the spinal cord and its nerves, which may cause
nerves to abnormally develop. This by itself may or may not
directly cause nerve damage. However, a second hit
occurs where the open nerve fibers are exposed to
the amniotic fluid, which can be damaging. And nerves can also
be directly damaged by trauma due to
bumping and rubbing against the uterine wall. In addition to the
spinal cord problems, patients with spina bifida can
develop two distinct problems related to the brain, buildup
of fluid within the spaces of the brain, called
hydrocephalus, and a sinking of the
lower part of the brain into the base of the skull,
known as hindbrain herniation or Chiari Malformation. In the normal brain,
the brain tissue contains and is surrounded by
cerebrospinal fluid, otherwise known as CSF. Normally most of the CSF fluid
is made by special tissue that lines the open
spaces within the brain called the ventricles. This fluid then
flows around the back of the brain in a region
that contains the cerebellum and brain stem, and
into the spinal canal to surround the spinal cord
all the way to the tailbone. In the case of spina
bifida, the defect at the bottom of the spine
allows the CSF to leak out the opening of the spinal
canal and pulls the brain downward into the base of
the baby’s skull, which is called Chiari II Malformation. This blocks the normal
flow of cerebrospinal fluid and causes the
ventricles to enlarge, a secondary brain abnormality
known as hydrocephalus. Traditionally, spina
bifida is repaired shortly after the baby is born. If the defect is diagnosed
during pregnancy, babies with spina
bifida are typically delivered by C-section. Because the spinal cord
defect does not directly affect the heart
or lungs, babies are generally very
stable and do not require any immediate treatment. Nonetheless, babies
are transferred to the neonatal intensive
care unit for close medication attention. At that point, neonatologists
and pediatric neurosurgeons work together to further
evaluate the baby and identify any
additional problems. They also prepare the infant
for repair of the spina bifida. A pediatric neurosurgeon
will perform the repair within the first
few days of life, and depending on the severity
of the hydrocephalus, infants may or may
not require a tube that drains the excessive
fluid from the brain at the same time. This tube is called a
ventriculo-peritoneal or VP shunt. Babies eventually
recover, and once stable, are able to go home. Children with spina bifida
are followed very closely by several pediatric
specialists, including a pediatric
neurosurgeon, pediatric neurologist,
pediatric urologist, pediatric orthopedic
surgeon, and pediatricians who specialize in spina bifida. In most centers,
including the Fetal Center at Children’s Memorial
Hermann Hospital, spina bifida
children are enrolled in a comprehensive program to
address their medical problems, monitor them for
long term problems, and provide support to families. Many of the complications
of spina bifida will not show until
later in life. As mentioned earlier,
these may include problems with walking, bowel
and bladder function, and neurological development. After the initial repair,
future operations and therapy may be needed to treat
the problems associated with spina bifida. For example, VP shunts are
placed to treat hydrocephalus. The VP shunt drains the
built-up fluid in the brain into the abdomen, where
it can be absorbed. This treatment can be
successful in managing many of the problems
that can occur in children with spina bifida. Although VP shunts are
effective in draining the fluid, they are mechanical
devices and they sometimes fail due to blockage or
movement and must be replaced. Shunts can also become
infected and require removal. A baby with spina
bifida will usually have several shunt revisions
in his or her lifetime. These treatments address the
problems associated with spina bifida, but unfortunately cannot
restore the nerve damage that has already occurred. Today, alternative options
exist to treat children with spina bifida. After decades of
research, surgery to repair the spina bifida
defect before the baby is born, also known as fetal
surgery, is a possibility for babies and mothers who
qualify for the procedure. In early 2011, The New
England Journal of Medicine published the results of the
Management of Myelomeningocele Study, or MOMS
trial, that studied the effects of fetal surgery
for the repair of spina bifida compared to the routine
care of surgery after birth. This study was sponsored by the
National Institutes of Health and was conducted
over eight years. The primary purpose
of the study was to determine if there was a
difference in infant death or need for a VP shunt
between fetal surgery patients and those repaired after birth. During the eight-year
period, more than 1,000 pregnant mothers
whose fetuses were diagnosed with spina
bifida were initially screened for the study. Due to a variety of factors
following additional exams and evaluation, 183
patients were randomly placed into two groups with 92
to the after birth repair group and 91 in the fetal
surgery repair group. Ultimately, the study
was stopped early when the committee that
was monitoring the results noted a clear benefit
to infants that had undergone fetal surgery. The study results were made
public in early February, 2011. For patients to be eligible
for the MOMS trial, they had to meet specific
maternal and fetal requirements. The fetal requirements
included but were not limited to a pregnancy
of a single fetus. Pregnancies with
twins were excluded, since the twin
without spina bifida would be put at higher
risk for premature delivery after fetal surgery. The pregnancy had
to be associated with a single fetus
between 19 and 25 completed weeks of gestation,
which was the time period for potential fetal surgery. To qualify for the
MOMS study, the mother had to be more than
18 years of age. Her body mass index, or
BMI, had to be less than 35, which is a number calculated
based on weight and height. A BMK greater than
35 is considered to indicate significant
obesity and would increase the risk of prematurity. A history of a previous
incision on the uterus, such as a classical C-section,
puts the pregnant patient at risk for scar separation
late in pregnancy and therefore was
excluded from the study. Because the risk
of preterm delivery is higher in patients
with fetal surgery, mothers with any
conditions or history that increased the risk
of preterm delivery, such as short cervix, were
also excluded from the trial. Additional risk factors
that prevented a woman from being included
in the study were insulin dependent diabetes,
infection with hepatitis B or C, HIV infection, red
cell aloe immunization, and unwillingness to
accept blood transfusions for various reasons. The unborn baby also had to
meet certain criteria in order to enter the MOMS trial. These included the presence of
a myelomeningocele beginning with the first
thoracic vertebra, T1, and the first sacral
vertebra S1 levels. Chiari II Malformation
had to exist at the time of evaluation. There could be no evidence
of an exaggerated curving of the spine. The spina bifida could
not be associated with other major fetal anomalies
such as a heart defect. Finally, the fetus had to
have normal chromosomes found by amniocentesis. Because of the research
aspect of this study, patients were carefully
chosen to maximize the benefits of fetal
surgery while minimizing the risks to both mom and baby. There were two main
outcomes of the study. The first was death or need for
a VP shunt by one year of age. The designers of the trial felt
that if the children did not receive a shunt by
one year of age, they were not likely to need
a shunt during their lifetime. The second main
outcome of the study was to measure the
mental and motor development using standardized
tests at 30 months of age. In addition to the
outcomes on the baby, one of the greatest
contributions from the MOMS trial was the
information provided on the risks of fetal surgery
for the pregnant mother. Some complications directly
affected the mother, while others were
effects of the pregnancy. 6% of women who
underwent fetal surgery suffered from extra
fluid on their lungs, known as pulmonary edema. This often requires
oxygen support but eventually correct itself. Problems with the membrane
sac that surrounds the fetus are a known complication
with any fetal surgery, and this was certainly
seen in the MOMS trial. One in four patients
was noted to have a separation of the membranes
from the uterine wall after the surgery. Membrane separation
is a risk factor which may lead to early delivery. Membrane separation occurred
in almost half of the patients after fetal surgery
and was six times more likely to occur than
when the spina bifida repair was postponed until
after the delivery of the baby. The risk for decreased
amount of amniotic fluid around the fetus, also
known as oligohydramnios, was twice as likely to
occur in the fetal surgery group as a result
of leakage of fluid through the surgical incision. Infection rates
were slightly higher in the fetal surgery groups. Any fetal surgery is at risk
for separation of the placenta from the uterus, also known
as placental abruption. This can occur at any
point during the surgery and afterward. Depending on the severity
of the abruption, some fetuses may require
emergent delivery. During the MOMS trial,
the obstetricians examined the uterine incision
used for the fetal spina bifida repair
earlier in pregnancy at the time of the
C-section delivery. They found that the
scar was very thin in one out of four
cases, and that there was evidence of
uterine scar separation in an additional 10% of cases. Keep in mind, most of
these complications are known problems
with fetal surgery and would have only been
expected in the fetal surgery group of patients. In normal pregnancies,
some of these problems can occur but are rare. Fetal repair of
spina bifida was also associated with
significantly increased risks for the newborn. Most of the neonatal
complications were related to the
prematurity at birth. The average gestational
age at delivery was about three weeks earlier
in the fetal surgery group, at 34.1 weeks versus 37.3 weeks. 13% of babies were delivered
before 30 weeks gestation. An additional one third were
delivered between 30 and 34 weeks, and another one
third were delivered between 35 and 36 weeks. This means that only
one in five babies that underwent fetal surgery
were delivered at term. Because of the
prematurity, birth weight, which corresponds with their
gestational age at birth, was less in the
fetal surgery group. The increased rate
of prematurity in the fetal surgery
group was also associated with a 21% incidence
of respiratory distress syndrome seen in
preterm infants, requiring oxygen and ventilator
support in the babies. This was three times higher
than the postnatal repair group. The benefits of fetal
repair of spina bifida appeared to be statistically
superior to postnatal repair. The primary outcome
of the study, which was death or
need for a VP shunt in the first year of life,
was 30% less frequent in the fetal surgery group than
in the postnatal repair group. The major differences
in the two groups appeared to be related to the
improvement of the Chiari II Malformation in the
fetal repair group. Babies who underwent
fetal repair were half as likely
to need a VP shunt at one year, 40% versus 82%. In addition, while
all fetuses that were entered into the
study had evidence of hindbrain herniation on
MRI during their mother’s pregnancy, it appeared that
the Chiari II Malformation was less common and
less severe among babies that underwent fetal surgery as
compared to postnatal repair. In fact, 36% of infants
who underwent fetal surgery had no evidence of hindbrain
herniation, compared to only 4% in the postnatal surgery group. However, at 12 months, there
was a higher percentage of infants needing
operations for tethered cord syndrome, a condition where
the spinal cord becomes stuck to the surrounding
tissue within the spinal canal, causing the spinal cord
to become abnormally stretched as the child grows. This occurred more often
in the fetal surgery group compared to the
postnatal surgery. At 30 months of age,
neurological outcomes were reviewed and mental
development in both groups was similar. However, motor
development scores seemed significantly better
in the fetal surgery group. While the ability
to walk depends on the level of the
spina bifida lesion, the study found that
twice as many children who underwent fetal surgery were
walking independently as compared to the postnatal
group, 42% in the fetal surgery group compared to only 21% in
the postnatal repair group. Overall, the degree of
disability in a child was lower among fetal
surgery patients. The MOMS trial was
a landmark study in the world of fetal therapy. Historically, fetal
surgery was used only for life-threatening conditions
in which the fetus would likely die during pregnancy
if left untreated. However, the MOMS trial
was the first study that demonstrated significant
benefit in children who had undergone
fetal surgery for spina bifida, a non-lethal disease. Careful analysis of
the study results demonstrated the benefits
outweighed the risks and harms of fetal surgery,
including those associated with the mother. Although there are still unknown
answers to many more questions, especially those about
long term outcomes, it appears that babies who
underwent fetal surgery have benefited in
the short term. Unfortunately, the MOMS trial
provides only statistics, and not specifics about
your baby, which is what all parents want to know. For many families, this
comprehensive multi-day evaluation and consultation
is the first opportunity to meet health care
professionals who specialize in this condition, and
ask questions and receive information specific to them. The extensive
consultation process is designed to help patients
learn about spina bifida and what life is like for
a child with the condition. Families also learn about
all of the treatment options so they have a full
understanding of the risks and benefits of conventional
treatment versus fetal surgery. When patients are referred
to the Fetal Center at Children’s Memorial
Hermann Hospital, they undergo comprehensive
evaluation and education consultations. This includes a
multi-disciplinary team approach, including
specialists from both maternal fetal medicine
and pediatric subspecialties. Before fetal surgery can
be considered further, thorough counseling
and evaluations are provided to ensure there
are no unnecessary risks to the mother, and that the baby
is in an appropriate candidate for surgery. Early in the evaluation process,
families meet a dedicated nurse coordinator from
the Fetal Center who will guide them through
a step-by-step process that includes the following. A maternal fetal
medicine specialist will perform a complete
maternal and pregnancy history evaluation and a
physical examination, and will evaluate
the fetal ultrasound to ensure there are no
other complications. Families will meet with a spina
bifida pediatric specialist, who will provide valuable and
unique information on what life is like for spina bifida
children and their families. The pediatric
neurosurgeons will educate families about spina bifida
and the surgical treatments involved with fetal surgery,
as well as postnatal surgery. If it has not already been
performed by your referring perinatologist. An amniocentesis
will be performed to be sure the fetal
chromosomes are normal. In any event, you will meet
with a genetic counselor to review your family’s
history for birth defects. In addition to the
consultation, patients undergo extensive testing. A comprehensive
ultrasound is performed to assess the presence of
the Chiari II Malformation and determine the level of
the spina bifida defect. A fetal MRI will
also be performed, as some features of
the spine and brain are better seen on MRI. MRI utilizes
magnetic waves, which are safe during pregnancy. For mothers and babies who
qualify for fetal surgery, additional consultations and
evaluations are necessary. An obstetric
anesthesiologist affiliated with the Fetal Center’s
multi-disciplinary team will meet with the mother,
assess any anesthetic risks, and explain any
anesthesia concerns. A neonatologist who specializes
in critically ill newborns will educate each family about
the potential complications of a premature birth. Preterm delivery is a potential
risk factor of fetal surgery. Families will meet
with a social worker to discuss the importance of
the family and friends support systems. Undergoing fetal
surgery is a commitment through the entire
pregnancy which requires the help of others
to ensure a safe pregnancy after fetal surgery. If there are other
small children at home, a child life specialist at
Children’s Memorial Hermann Hospital will meet
with each family. This individual will
provide valuable tools to help explain the unborn
baby’s surgery to the baby’s siblings. Finally, families will
meet with the fetal surgery specialist who will be
involved in the surgery. The Fetal Center’s
affiliated team will go over the
actual procedure and answer any questions
you may still have. Fetal surgery is not
for every patient. Often patients do not qualify
because of reasons involving the fetus, and sometimes
they don’t qualify because of maternal factors. There are also families who
qualify for fetal surgery but do not think it is the best
option for them after spending time learning about spina
bifida and fetal surgery. For those who qualify
for fetal surgery, we typically ask
families to take a few days to consider
all of the options that have been presented with. Undergoing fetal
surgery for your baby is a major commitment,
and a lifestyle change for the remainder
of the pregnancy and future pregnancies. It typically includes a
five-day hospitalization following the fetal surgery,
three weeks of strict bed rest after the procedure,
and weekly ultrasounds to monitor the fetus and
assess for complications of the surgery. More importantly,
there maybe prolonged subsequent hospitalizations
during the pregnancy if complication should arise. Membrane separation,
preterm labor, or leakage of amniotic
fluid may require you to stay in the
hospital for the remainder of your pregnancy. Should you elect to proceed
with fetal intervention, your surgery will
typically be scheduled before 26 weeks gestation. Fetal surgery for spina bifida
is a complicated operation that requires the expertise of
many physicians and surgeons. Two patients are
undergoing an operation, the unborn baby
with spina bifida, and the pregnant mother. Care of the mother starts before
entering the operating room. During the morning of
surgery, the mother and baby undergo another full assessment,
including a fetal ultrasound. An epidural for
post-operative pain control is placed before surgery. Once inside the operating
room, the mother and baby are again evaluated
prior to the mother falling asleep with
guided anesthesia. Meanwhile, the
entire surgical team is preparing for the operation. Mothers undergoing
fetal surgery are administered general
anesthesia and an epidural for pain control. The skin incision is
similar to an incision used for cesarean
section deliveries. As the pregnant
uterus is exposed, the well-being of the fetus
and position of the placenta is again reevaluated
via ultrasound. The monitoring
process is continued throughout the entire operation. In order to expose
the back of the baby, the uterus is opened with an
incision called a hysterotomy. The location of the
incision is made to provide the best exposure of
the spina bifida of the baby. Careful attention is made
to avoid the placenta and large blood vessels
within the uterine wall, as both are important
for the baby’s stability. A stapling device especially
designed for fetal surgery is used to make the incision to
prevent unnecessary bleeding. An opening in the uterus
is made in an area away from the placenta
just large enough to expose the baby’s back to
see the spina bifida defect. Once the uterus is
open, only the area of the back with
the spina bifida is exposed for the operation. The normal amniotic
fluid is removed, and warm fluid is
circulated into the uterus to replace it during
the operation. This keeps the fetus
warm and prevents kinking of the umbilical cord. Once the baby is
properly positioned, pediatric neurosurgeons repair
the defect in much the same way they would after birth. Once the spina bifida is
repaired, the uterus is closed. Throughout the entire
procedure, the baby and mother are continuously monitored by
the surgical and anaesthesia teams. The entire fetal surgery
team works together to accomplish a very safe
and efficient operation for both patients. While the fetal surgery team is
working during the operation, the neonatology team
is on standby, prepared to act quickly if the
fetus demonstrates any signs of
instability that would require immediate delivery. After surgery, you
will be awakened from general anesthesia and
go to recovery in your room in the labor and
delivery unit, where you will receive one on one
nursing care for the first two days. Both you and your baby are
monitored during the remaining hospitalization. The first day after surgery
is the most difficult. You will be asked to
stay in bed and not allowed to drink or eat. Most patients have a hot
and flushed sensation and often describe their
feeling as losing a day. This is due to a
medication called magnesium sulfate that helps
prevent uterine contractions. As you continue to
improve, this IV medication will be changed to an
oral medication, which you will continue for the
remainder of your pregnancy. You will be slowly encouraged
to eat, drink, and get out of bed over the next few days. The epidural for pain
control will be changed to oral medications as well. Typically, mothers stay at
Children’s Memorial Hermann Hospital for five to seven days
following surgery for recovery and evaluation, followed by
a two-week stay in Houston for further monitoring. Often, patients choose to
transfer their obstetrical care to an affiliated physician and
deliver at Children’s Memorial Hermann Hospital. The team of coordinators
at the Fetal Center works closely with families
to make arrangements for their entire
stay in Houston. If you choose to return
to your local obstetrician for delivery, the team
at the Fetal Center will work closely with
the referring physician to ensure an open
line of communication and coordinate your care
throughout the remainder of your pregnancy. Several complications
may occur after surgery, and can occur during the
hospitalization or thereafter. Upon discharge
from the hospital, patients and their families are
given very specific monitoring instructions to look
for signs of problems. These include contractions,
leaking of amniotic fluid, bleeding from the
vagina, fevers, and separation of the amniotic
membranes based on ultrasound. If you begin to experience
uterine contractions, please contact the Fetal
Center or your family physician immediately, because
only 20% of pregnancies reach term delivery
after fetal surgery. Mothers who have
undergone surgery can go into labor at any time. Since the fetal membrane around
the sac containing the baby were entered during
the surgery, there is a significant risk of
leaking amniotic fluid. Patients will usually experience
fluid coming out of the vagina when they first stand up. This is a serious
complication of the surgery, as it can lead to infection. If this occurs, seek
immediate medical attention. If such leakage
occurs, you will be likely in the hospital for the
remainder of your pregnancy. Bleeding from the
vagina may be a sign of abruption, a
critical situation where the placenta is
becoming dislodged from the uterine wall. Because this can have
serious consequences, please contact the Fetal Center
or your physician immediately. During weekly ultrasounds
after discharge, the fetal membranes
may become separated from the uterine wall. This is called
chorioamnion separation. This condition puts
you at high risk for leaking amniotic fluid. If membrane separation is
detected by ultrasound, you will be admitted to the
hospital for observation for the remainder
of your pregnancy with potential for
early delivery. In about 20% of cases
in the MOMS trial, patients experienced
no complications and underwent a
scheduled delivery by C-section at 37
weeks gestation. Even though this gestational
age three weeks earlier than the usual due date
at 40 weeks gestation, your fetal surgery team feels
that a delivery at 37 weeks is relatively safe for the
baby while minimizing the risks of spontaneous delivery. 37 weeks is also picked
as a time for delivery to keep the fresh scar
from your fetal surgery from stretching too much
as the uterus gets bigger, and to prevent tearing
with labor contractions. Because the heart
and lungs are usually normal in babies
with spina bifida, most infants are
stable at delivery but will receive
their initial care in the neonatal
intensive care unit. Although the MOMS trial was a
well-designed clinical study, it only provides
overall statistics for the benefits
of fetal surgery compared to postnatal
repair of spina bifida. It incorporated various
types of patients with various severities of
spina bifida, all of which have unique outcomes. Although many
patients may medically qualify for fetal
surgery, fetal surgery may not be the right choice for
every mother and her family. Many factors go into this
decision making process, including maternal health and
family well-being in addition to the overall
health of the baby. Most parents ask
about the outcome if they decide on fetal surgery. Although physicians
do everything possible to minimize
the risks of surgery, there is no way to
predict the exact outcome. The Fetal Center at Children’s
Memorial Hermann Hospital and the affiliated physicians
at UT Health Medical School value the importance
of patient education. Not every patient will
require fetal surgery, but every family deserves
to be thoroughly educated about their child’s condition
and the expected outcomes based on the specific findings
of their child’s condition, as well as a complete
understanding of how this will affect their child’s
life and the family throughout their lifetime. The Fetal Center at Children’s
Memorial Hermann Hospital is a multi-disciplinary
clinical and research center whose affiliated physicians are
faculty members at UT Health Medical School in
Houston, Texas. The Fetal Center provides
comprehensive maternal, fetal, and neonatal health
care to pregnant women whose unborn babies have
been diagnosed with a birth defect or a genetic condition. Located in the heart of the
world-renowned Texas Medical Center, the Fetal Center at
Children’s Memorial Hermann Hospital includes
affiliated fetal, pediatric, and adult specialists
who provide a superior level of care for
high-risk expectant mothers with complex disorders
of the fetus. The Fetal Center and its
affiliated physicians offer coordinated maternal,
fetal, and neonatal care by providing a full spectrum
of prenatal diagnostic evaluations, fetal surgery,
and follow-up care. For all conditions,
the Fetal Center works closely with
patients to deliver the most comprehensive care
for mothers and their babies. The Fetal Center’s
affiliated physician team aims to provide all families
with a complete understanding of their child’s
condition and prognosis through prenatal counseling
and educational materials. Patients are evaluated
with advanced fetal imaging including fetal MRI and
fetal echocardiography to provide the most
accurate prenatal diagnosis. This educational video,
produced by the Fetal Center at Children’s Memorial
Hermann Hospital, is designed to provide an
overall understanding of spina bifida and available
treatment options. It should be used in conjunction
with personal evaluations and consultations
with your doctor. Patients should not base
decision making solely on the information
provided in the video. The physicians affiliated
with the Fetal Center at Children’s Memorial
Hermann Hospital provide medical services
as members of UT Health and the University of
Texas Health Science Center at Houston.


  1. yo soy madre de una niña con hidrocefalia y mielomeningosele kiero saver si eya ba. a yegar a caminar o no ya está operada y cada cuanto se les cambia la válvula

  2. My mom had 9 pregnancies in total 5 of us all were born with spina bifida nd out of the 5 I was the only one tht survived nd my mom was told tht i would never walk but doctors were wrong cuz from 9 months to 1 yr old I was given pt nd ever since about 2 yrs ive walked with jus little assistance . 💪 Nd my doctor's call me the miracle child

  3. Went for our twenty week scan two weeks ago got told something wasnt right week later another scan and got told our baby had spina bifeda so two weeks of hurt Mrs needed an injection in her womb to check the amount of damage which itself can cause miscarriage they came bk all clear went to Liverpool womans hospital on Monday and got told our baby was perfectly normal we couldn't believe what we heard and still in shock now

  4. Is it grows by time and harmfull to future life …plz reply …..bcoz I m pregnant and Dr says u should abortion of this. …plz guide about this problem

  5. My baby is bron with spina bifida 1week ago। I wanna know he must have a normal life like other children

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