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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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Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusions

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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Acknowledgements

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

Authors

Contributions

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.

Corresponding author

Correspondence to Suhas Udayakumaran.

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Ethics approval and consent to participate

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

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Not applicable

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None declared.

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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). https://doi.org/10.1007/s00381-022-05562-z

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