Spina Bifida

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Spina Bifida of Greater New Orleans

Spina bifida is one of the most common birth defects and myelomeningocele is the most common and severe form of spina bifida.

In utero correction of myelomeningocele is an extremely complex procedure available only to qualified candidates. Our team is committed to maintaining optimal patient safety to ensure the best possible outcomes for you and your baby.

What causes this condition

This condition occurs where there is a problem with cerebrospinal fluid (CSF), which surrounds the brain and spinal cord. CSF normally moves around the brain and spinal cord, cushioning it, and is eventually absorbed into the bloodstream. Levels can rise if the flow is blocked, if CSF isn’t properly absorbed or the brain is making too much of it. Too much CSF puts pressure onto the brain. The condition is common in babies who have a myelomeningocele, where the spinal column does not close properly.

How this condition is treated

Fetal surgery for myelomeningocele, the most severe form of spina bifida, is not a cure, but studies show that prenatal repair can offer significantly better results than traditional postnatal repair. This procedure greatly reduces the need to divert fluid from the brain, improves mobility and improves the chances that a child will be able to walk independently.

The surgery

Prenatal repair of myelomeningocele is performed between 19 and 25 weeks’ gestation.

During the surgery, the fetal surgeon performs a laparotomy (an incision across the mother’s abdomen). A stapling device that pinches off all blood vessels to the uterus and keeps membranes secured to the muscle. Using ultrasound to locate the placenta and fetus, the baby is rolled onto its back.

A pediatric neurosurgeon removes the MMC sac, if one is present, returns the spinal cord to the spinal canal, and closes the surrounding tissue and skin over the defect to protect the spinal cord from exposure to the amniotic fluid. The uterus and the abdominal incision are then closed. Throughout, the baby and mother are monitored by adult and fetal specialist to ensure maximum safety.

After surgery

Following surgery, women will have a three to five day hospital stay followed by modified bed rest for up to four weeks in order to reduce preterm labor. Weekly followup visits and monitoring will continue until the baby is born.

If labor does not begin sooner, your baby will be delivered by planned cesarean section at 37 weeks. After delivery, your baby will be cared for in our Newborn and Infant Intensive Care Unit (NICU).

After delivery

Following your baby’s birth, he will stay in the NICU. This can be a scary time, but be assured he will be closely monitored by a multidisciplinary team of specialists. To better understand what will happen, below is what you can expect during your baby’s stay:

  • Head ultrasounds on the day of delivery and prior to discharge.
  • MRI to evaluate your baby's brain and spine.
  • Daily head circumference measurement.
  • Renal and bladder ultrasound at 2 days old.
  • Bladder scans with a handheld ultrasound device every four hours for the first 48 hours to estimate the amount of urine in the bladder and whether your baby will require a catheter.
  • Clean intermittent catheterization if your baby's bladder volume is greater than 50 percent of expected volume.
  • Video-urodynamics at 2 days and 2 months of age. A special catheter measures pressure when the bladder is full. A soft catheter in the rectum measures abdominal pressure on the bladder. A uroflo chair measures urine flow rate and time needed to empty bladder.
  • Measures to prevent urinary tract infection.
  • Evaluation for shunt.