Question

Clinical Case 13 A 22-year-old woman presents to the emergency room. She is obviously pregnant and near term. There has been no prenatal care. A uterine ultrasound is performed that detects an abnormality. She is estimated to be 37 weeks pregnant. The obstetrician on call wishes to perform an emergency Caesarian section delivery because of the abnomality that was detected. This was performed without incident. Examination of the newborn shows a fist-sized mass in the midline lumbosacral region. This protrudes above the skin surface and is dusky gray in appearance, The newborn has a normal cry and arms seem to move normally. Skin color is normal and temperature is normal. The legs do not move and are flaccid. There is deformity noted of the hips, ankles, and feet. Subsequent examination reveals a lack of cry or any physical response to sensory stimulation of the legs.

Answer 1

The newborn has a congenital anomaly called as Spina bifida in which the spinal cord doesn't close completely before birth leading to protrusion of the spinal contents in form a meningocele.

This may be because of lack of folic acid intake during pregnancy, obesity ,family history and environmental factors.

The condition will lead to loss of sensation in lower limbs, incontinence,hydrocephalus

This is diagnosed by ultrasound, maternal serum alpha feto protein are increased

The newborn can be treated surgically by reusing the spine ,shunting in case of hydrocephalus ,anticholinergic to control bladder or symptomatic treatment

This could be prevented by proper prenatal screening , folate supplements

Appropriate and timely treatment can have a better prognosis and most of the child can reach their adulthood .