Fetal Spinal Bifida

When an ultrasound detects something out of the ordinary, it’s natural for expectant parents to be worried. But new technologies and procedures, as well as a better understanding of fetal development, can help address potential birth defects. That’s the case with spina bifida, a defect that occurs during the first month of pregnancy when the spinal column does not develop properly.

For many expectant mothers who learn their developing babies have spina bifida, the answer may be in-utero surgery to better the quality of life for their children. Previously, moms-to-be had to travel around the country for this life-changing surgery. Today, the new team at Orlando Health Winnie Palmer Hospital for Women & Babies is performing in-utero surgery to help correct spina bifida right here in Central Florida.

Led by pediatric neurosurgeon Dr. Samer Elbabaa, the Orlando Health Winnie Palmer team of fetal care experts is here to guide you through your pregnancy. They have the experience and knowledge to provide the best care for babies with spina bifida while allowing you to choose a treatment plan for your family. At the Fetal Care Center, we strive to anticipate and meet all your needs during pregnancy and even after birth. Orlando Health Arnold Palmer Hospital for Children provides comprehensive follow-up care through early adulthood for children with spina bifida.

What is spina bifida

Spina bifida is a neural tube defect that occurs during the first month of pregnancy when the spinal cord does not develop or close properly. This defect can be so mild that some people do not even know they have it. In its most severe form, the defect leaves a section of the spinal cord and nerves exposed in a sac on the patient’s back.

Spina bifida can lead to many physical disabilities, including problems with walking and mobility, bowel and bladder function, wounds healing and fluid accumulating in the brain (hydrocephalus) requiring shunt surgery.

Spina bifida occurs in approximately four out of every 10,000 live births in the United States. About 166,000 people in the U.S. live with this birth defect.

Types of spina bifida

Myelomeningocele is the most common and severe form of spina bifida. This birth defect means that the spinal canal is open along a portion of the middle or lower back. In that area, the spinal cord and nerves push through the baby’s back, forming a sac on the outside of the body that can make the baby prone to life-threatening infections.

Meningocele is a less severe form of spina bifida that is similar to myelomeningocele but the sac is filled with fluid rather than the spinal cord.

Spina Bifida Occulta is the separation between one or more bones of the back called vertebrae. Because the nerves are not involved in this birth defect, there are few, if any, signs or symptoms. Most people with this form of spina bifida are unaware they have it.

How we treat spina bifida

Spina bifida usually is diagnosed during pregnancy through routine ultrasound screening of the fetus. Once that occurs, our doctors may determine that some babies are candidates for in-utero surgery to repair the defect. This type of treatment is performed between 19 and 26 weeks of pregnancy because the fetus is considered viable and could survive if an emergency delivery were required. Not every baby with spina bifida is a candidate for surgery, but those that are tend to have better results with in-utero surgery than waiting for an operation after delivery. Our fetal surgery team follows the inclusion and exclusion criteria of the MOMS trial. Every mother and her fetus undergo a thorough workup to determine their candidacy for fetal surgery.

What to expect with spina bifida surgery

During in-utero spina bifida surgery, a team of doctors with a range of specialized skills will be present in the operating room to take care of the mother and the baby. The team at Orlando Health Winnie Palmer Hospital for Women & Babies includes pediatric neurosurgeon Dr. Samer Elbabaa, clinical perinatologist Dr. Cole Greves, maternal fetal physician Dr. Gregory Locksmith, an obstetric anesthesiologist, a pediatric anesthesiologist and and a neonatology specialists.

After in-utero spina bifida surgery

Mothers usually remain in the hospital for three to five days after surgery and are on modified bed rest for three to four weeks after surgery to reduce the risk of preterm labor. Expectant mothers who’ve had fetal surgery are scheduled for a C-section (Cesarean birth) by 37 weeks.

Results of spina bifida surgery

Fetal surgery for spina bifida is not a cure, but studies show that prenatal repair can offer significantly better results than traditional post-delivery repair. Spina bifida is on a spectrum and those affected can have different challenges, including both physical and mental impairments. Fetal surgery for spina bifida has been proven to greatly reduce the need to divert spinal fluid from the brain and can improve mobility and the possibility that a child will be able to walk independently or with minimal assistance.

Causes of spina bifida

There is no known cause of spina bifida, but doctors suspect it is caused by a combination of genetic and environmental risk factors. Among those risk factors:

  • A family history of neural tube defects in either the mother or the baby’s siblings.
  • A deficiency in folate, which also is known as vitamin B-9: Folate can be found in foods such as leafy greens, beans, citrus fruits and eggs. The synthetic form, called folic acid, can be found in supplements and fortified foods.
  • Some medications: The anti-seizure medicine valproic acid (Depakene) is thought to increase the risk of spina bifida because it interferes with the body’s ability to use folate and folic acid.
  • Diabetes: Uncontrolled blood sugar in the mother can increase the risk of spina bifida in an unborn baby.
  • Obesity: If a woman is significantly overweight before becoming pregnant, she faces an increased risk of neural tube birth defects, including spina bifida.
  • Elevated body temperature: When a woman’s core body temperature increases from factors such as fever or the use of a hot tub or sauna during the first month of pregnancy, it may increase the risk of spina bifida.

Prevention

Because spina bifida and other neural tube defects occur in the first few weeks of pregnancy, it is critical for expectant mothers to have enough folic acid in their systems at the time of conception. Because of this, doctors recommend that all women of childbearing age take a supplement of 400 micrograms of folic acid every day. It is difficult to meet the suggested daily amount of folic acid through food alone, but eating a diet rich in folate also is important.