Fetal anal incontinence evaluated by amniotic fluid digestive enzyme assay in myelomeningocele spina bifida.
The goals of this study were to determine whether anal sphincter dysfunction in spina bifida develops during fetal life or after birth and whether it reflects the severity of spina bifida and therefore can be used as a criterion to select the cases that could benefit from in uterosurgery. Total protein and digestive enzyme activities [gamma-glutamyl transpeptidase (GGTP), aminopeptidase M (AMP), and alkaline phosphatase isoenzymes including the intestinal form (iALP)] were assayed retrospectively in amniotic fluid from 80 myelomeningocele spina bifida cases without unrelated associated malformation (gestational age 14-33 wk). A normal enzyme activity profile was observed in 46 of the 80 cases. Two abnormal profiles were observed: 1) bilious vomiting, characterized by abnormally high GGTP and AMP activities but normal iALP, and 2) digestive enzyme leakage, characterized by abnormally high activities of GGTP, AMP, and iALP, typical of anal incontinence. No relation was observed between these enzyme activity profiles and the different secondary signs of spina bifida or the level of the damage. In conclusion, anal sphincter dysfunction in spina bifida revealed by amniotic fluid digestive enzyme activities occurred before 24 wk in fetal life in 28.7% of cases. This criterion may be indicative of the severity of spina bifida and therefore perhaps could be used to select cases that are suited to in utero surgery. It could also be used to establish the potential benefit of this surgery in fecal incontinence.
Talabani
Hana
H
Biochimie Hormonale, Hôpital Robert Debré, Paris, France.
Dreux
Sophie
S
Luton
Dominique
D
Simon-Bouy
Brigitte
B
Le Fiblec
Bernard
B
Col
Jean-Yves
JY
Guibourdenche
Jean
J
Oury
Jean-François
JF
Muller
Françoise
F
D000469:Alkaline Phosphatase / Q000378:metabolism; D000649:Amniocentesis; D000653:Amniotic Fluid / Q000378:metabolism; D001003:Anal Canal / Q000196:embryology* / Q000473:pathology; D018826:CD13 Antigens / Q000378:metabolism; D004305:Dose-Response Relationship, Drug; D005242:Fecal Incontinence / Q000150:complications*; D005260:Female; D005315:Fetal Diseases / Q000175:diagnosis; D005865:Gestational Age; D006801:Humans; D007223:Infant; D008591:Meningomyelocele / Q000150:complications*; D011247:Pregnancy; D011296:Prenatal Diagnosis; D013116:Spinal Cord / Q000473:pathology; D016135:Spinal Dysraphism / Q000150:complications*; D013997:Time Factors; D016216:Ultrasonography, Prenatal; D005723:gamma-Glutamyltransferase / Q000378:metabolism
D005723:gamma-Glutamyltransferase; D000469:Alkaline Phosphatase; D018826:CD13 Antigens