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Avoiding the antenatal counselling faux pas: bridging the gap between prenatal prognostication and postnatal outcome of closed spina bifida

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Closed spina bifida (CSB) is rare in prenatal literature, and various lesions are grouped under this broad nosological entity CSB, leading to confusing and misleading prognostic conclusions.


This is a retrospective observational cohort study of prenatally detected CSB cases using two-dimensional ultrasound, complemented by three-dimensional ultrasonography and foetal MRI in indicated cases, from October 2014 to October 2021 in a tertiary-level single centre.


The most common upper vertebral level of CSB was lumbar in 66.6% (10/15). The sub-classification of lesions based on prenatal ultrasound showed an agreement in 53% of the cases. Sixty percent had associated abnormalities identified postnatally, the most common being anorectal malformation seen in 33.3%. On postnatal follow-up, 46.6% had bowel incontinence and bladder dysfunction, and 33.3% developed lower limb deformities.


All CSBs do not have a uniformly favourable prognosis. The prognosis of CSB depends on the pathological type, the presence of associated abnormalities and the management.

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We acknowledge the support from Dr. Sheela Namboothiri, the paediatric geneticist at our institute. We also extend our special thanks to Dr. Sushmita Namdeo for contributing to the ultrasound images submitted.

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Authors and Affiliations



Conceptualisation: Suhas Udayakumaran. Methodology: Rinshi Abid Elayedatt, Suhas Udayakumaran. Formal analysis and investigation: Rinshi Abid Elayedatt, Suhas Udayakumaran. Writing — original draft preparation: Rinshi Abid Elayedatt, Suhas Udayakumaran. Writing: Rinshi Abid Elayedatt, Suhas Udayakumaran, Vivek Krishnan. Resources: Rinshi Abid Elayedatt, Suhas Udayakumaran, Vivek Krishnan. Supervision: Suhas Udayakumaran.

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Correspondence to Suhas Udayakumaran.

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Approved by the institutional ethical committee (ECASM-AIMS-2021-126), and informed written consent was obtained from all women.

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Key Points

• All closed spina bifida does not have a uniformly favourable prognosis.

• Prognosis depends on the pathological type of CSB, the level of the lesion and the presence of associated abnormalities at presentation and surgical treatment.

• CSBs can produce progressive neurological and orthopaedic dysfunction later in childhood or adult life.

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Udayakumaran, S., Elayedatt, R.A. & Krishnan, V. Avoiding the antenatal counselling faux pas: bridging the gap between prenatal prognostication and postnatal outcome of closed spina bifida. Childs Nerv Syst 38, 1751–1762 (2022).

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