Meningomyelocele: management in utero and post natum.
We report a four year follow-up of 39 of 47 infants born after pre-labour Caesarean section and 68 of 79 born vaginally. Loss of motor function due to late complications was more frequent in the Caesarean section group (Fisher's Exact; P = 0.004). However, the means of the differences between the X-ray levels (measured as the last intact vertebral arch seen on standard anteroposterior roentgenograms of the spinal column) subtracted from the motor levels still favour Caesarean section (mean = 3.24; SD = 2.7) over vaginal delivery (mean = 1.2; SD = 2.7) (Student's t-test; P = 0.0003). The frequencies of other complications, death and neonatal meningitis, were not significantly different. Another 38 infants born by Caesarean section after labour were more paralysed (mean of X-ray and motor difference = 1.8, SD = 2.2) following rupture of amniotic membranes than those with intact amniotic membranes with or without labour (mean = 3.4; SD = 2.2) (Student's t-test; P = 0.0067). The differences between X-ray and motor levels for patients born by Caesarean section with intact amniotic membranes and without labour (mean = 3.6; SD = 2.4) were not significantly different from those with labour and intact amniotic membranes (mean = 2.89; SD = 1.5). The number of new cases of meningomyelocele presenting to our clinic has decreased from an average of 30 per year between 1970 and 1987 to 14 between 1988 and 1992.
Shurtleff
D B
DB
Department of Pediatrics, University of Washington, Seattle 98105.
Luthy
D A
DA
Nyberg
D A
DA
Benedetti
T J
TJ
Mack
L A
LA
D002585:Cesarean Section; D036861:Delivery, Obstetric / Q000379:methods; D005321:Extraembryonic Membranes; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008591:Meningomyelocele / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D010243:Paralysis / Q000209:etiology; D011247:Pregnancy; D011295:Prenatal Care; D011296:Prenatal Diagnosis