The outcome of pregnancies diagnosed as having a fetus with meningomyelocele.
Forty-nine cases of meningomyelocele diagnosed in utero and another 10 cases delivered by prelabor cesarean section (N = 59) are compared to all other cases of meningomyelocele (N = 98) born following labor and seen during the same period. Prenatal diagnosis was established for 19 cases before and 30 cases after 24 weeks gestational age. Ten cases were delivered by prelabor cesarean section for maternal indications. Eight of 12 cases diagnosed before 24 weeks and given a guarded prognosis and one given a poor prognosis, elected cesarean section. One of the 8 was stillborn. Four of the 12 given a guarded prognosis and 6 an extremely poor prognoses elected termination of the pregnancy. Nineteen of the 30 cases diagnosed after 24 weeks were delivered by prelabor cesarean section and two by cesarean section after inadvertent labor. Of the 35 cases born by prelabor cesarean section, 48% have sacral levels or no loss of motor function compared to 14% of the 98 born after labor (P = 0.0001). We recommend prelabor cesarean section before onset of labor to preserve neural function of a baby with meningomyelocele and leg movement in utero when parents refuse termination or have a diagnosis made after 24 weeks gestational age.
Shurtleff
D B
DB
Dept. of Pediatrics, University of Washington, Seattle 98195.
Luthy
D A
DA
Benedetti
T J
TJ
Hickok
D E
DE
Stuntz
T
T
Kropp
R J
RJ
D002585:Cesarean Section; D005260:Female; D005323:Fetal Monitoring; D006801:Humans; D007231:Infant, Newborn; D007866:Leg / Q000503:physiopathology; D008591:Meningomyelocele / Q000175:diagnosis* / Q000601:surgery; D009068:Movement; D010243:Paralysis / Q000517:prevention & control; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D011296:Prenatal Diagnosis; D011379:Prognosis; D014463:Ultrasonography