Cesarean section before the onset of labor and subsequent motor function in infants with meningomyelocele diagnosed antenatally
Meningomyelocele is a birth defect in which part of the spinal cord and membranes surrounding it protrude through a defect in the vertebral column; it is often associated with impaired motor capability in the child. The condition can be detected in most cases by prenatal testing, and many mothers elect termination of the pregnancy. It has been suggested that the method of delivery affects the outcome for fetuses with meningomyelocele, since labor and vaginal birth exert pressure on the damaged tissues, exacerbating the malformation. The records of all infants delivered with meningomyelocele during a 10-year period at two medical institutions were reviewed. Cesarean section was offered to and accepted by all mothers of term fetuses diagnosed prenatally who did not have additional complications. One hundred sixty infants survived the period immediately after birth, of whom 47 were delivered by cesarean section before labor began, 35 were delivered by cesarean section after labor had started, and 78 were delivered vaginally. The difference between the anatomical level of the lesion and its motor (functional) level was greater for the cesarean-before-labor group than for either of the other two groups: this represented considerably enhanced motor function for those delivered before labor began. Infants who underwent labor had more severe degrees of paralysis than those delivered by cesarean section: while 45 percent of the cesarean-before-labor group had no motor loss or losses at the sacral level only (the lowest portion of the spinal cord), this was true of only 16 percent of those who underwent labor. The chance of severe paralysis was more than twice as great for infants exposed to labor than for those in the cesarean-before-labor group. Tests of intellectual performance, carried out up to 24 months of age, did not find differences among the infants according to mode of delivery. Thus, the negative effects of labor appeared confined to motor function. Prenatal diagnosis of meningomyelocele and subsequent delivery by cesarean section is likely to improve motor function for affected children. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: The New England Journal of Medicine
Role of prenatal ultrasonography in women with positive screen for Down syndrome on the basis of maternal serum markers
The use of ultrasound may increase the detection rate of fetuses with Down syndrome among mothers whose blood has tested positive for three markers for Down syndrome. Researchers performed ultrasound exams of 395 pregnant women whose blood tested positive for three markers of Down syndrome. Amniocentesis or follow-up after birth predicted that 374 fetuses had normal chromosome patterns, but 18 of these fetuses actually had Down syndrome. Ultrasound examination of these 18 fetuses detected abnormalities in nine of them. Abnormalities detected by ultrasound that were most likely to be associated with Down syndrome were thickened neck skin, abnormal bowel, and short thigh bone. The use of ultrasound to detect abnormal development along with the positive blood tests may reduce the need for amniocentesis to detect Down syndrome.
Publication Name: American Journal of Obstetrics and Gynecology
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