Fetal surgery for open spina bifida TOG 2019

Question 1

By which gestation should the neural tube be closed?

Answer 1

28 days

Question 2

Worldwide incidence of spina bifida?

Answer 2

4.6/10,000
UK 700-900 pregnancies per year

Question 3

Diagram showing spina bifida occult and myelomeningocele

Answer 3

Question 4

Impact of spina bifida

Answer 4

Mobility - higher the lesion the worse.
Orthopaedic- talipes, kyphosis, scoliosis
Neurogenis - bladder/boweol control, sexual dysfunction
Brain - Arnold-Chiarti (hindbrain herniation), hydrocephalus

Question 5

How much does folic acid supplementation reduced risk of spina bifida in high risk groups?

Answer 5

70%

Question 6

What proportion of women in UK take preconception folic acid 400ug for 2 month preconception

Answer 6

20%
Foods not fortified

Question 7

When is spina bid screened for

Answer 7

18-20+6 USS

Question 8

If diagnosed wha proportion of families choose to terminate the pregnancy?

Answer 8

80%

Question 9

When should surgery for spina bifida be performed?

Answer 9

Within 1st 48 hours of life.

Question 10

Pros & cons in utero open surgery

Answer 10

Improve short term outcomes for child, risk prematurity