This literature review attempts to update concepts regarding the diagnosis, prevention and management of prenatal spina bifida. Spina bifida is a congenital malformation resulting from defects in neural tube closure. Infants with this condition require surgery in the first days of their life and show varying degrees of sequelae. In the US affects 3.4 per 10,000 live births. In Chile, after fortification of flour with folic acid incidence of spina bifida is 3.9 per 10,000 births, 40% less than in the pre- stage fortification. The diagnosis may be suspected early by an ultrasound between 11 and 14 weeks with the evaluation of intracranial translucency and confirmed in the second quarter with the same method, looking for classic signs. They are useful complementary studies with 3D ultrasound and MRI to better define prognosis and confrontation. The traditional postnatal surgical treatment is added in recent years, in selected cases, the alternative of antenatal surgery with positive results that exceed the postnatal treatment. In Chile there and experience with 26 cases of fetal surgery for spina bifida. There is no complete consensus regarding the most appropriate route of delivery, although the trend is toward resolution by cesarean section.
Key-words: Spina bifida; congenital malformation; neural tube; prenatal diagnosis; fetal surgery. |
