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Other Neurologic Diseases in Pregnancy
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
Loralei L. Thornburg, Meredith L. Birsner
Women with congenital spinal lesions such as meningomyelocele should be made aware of the increased risk of spinal cord lesions to their offspring and placed on 4 mg/day of folic acid prior to conception [1]. All other patients should take the standard of at least 400 mg of folic acid preconception.
Biofeedback Treatment for Fecal Incontinence
Published in Han C. Kuijpers, Colorectal Physiology: Fecal Incontinence, 2019
Most reports concerning biofeedback have employed the technique as originally described or with slight modifications. In the largest published series, 36 of 50 patients reported that the frequency of incontinence decreased at least 90% following therapy.2 Those who did well had a substantial lowering of thresholds of external sphincter contraction following conditioning, whereas poor responders had no improvement. In most series, the best results have been obtained when fecal incontinence is due to anal sphincter surgery or trauma; somewhat lower rates of success have been reported with idiopathic fecal incontinence, diabetes mellitus,11 and associated irritable bowel syndrome (Table 1). Some children with meningomyelocele have also improved with biofeedback, but success rates are low.9,12,14 Finally, biofeedback has been reported to be effective in fecally incontinent children with previous surgical repair of an imperforate anus.7 Decreased frequency of fecal incontinence was associated with increased awareness of rectal distension, but no increase in voluntary contractile pressures of the lower anal canal.
Fetal malformations detected with magnetic resonance imaging in the diabetic mother
Published in Moshe Hod, Lois G. Jovanovic, Gian Carlo Di Renzo, Alberto de Leiva, Oded Langer, Textbook of Diabetes and Pregnancy, 2018
Spina bifida (the so-called meningomyelocele) is a common fetal malformation of the CNS. It can cause a significant neurological handicap. In utero surgical restoration of meningomyelocele has been increasingly offered after the result of a randomized trial of prenatal versus postnatal repair of myelomeningocele (MoMs trial) suggested its benefit of decrease postnatal shunt placement and improved motor outcomes.24 Fetal MRI has been advocated in this trial to detect hindbrain herniation, as shown in Figure 42.14. This is used not only for prognostic purposes but also to monitor the possibility of reversal of hindbrain herniation in cases that opted for in utero repair. Comparison of advantages and disadvantages between ultrasound and MRI in imaging of fetal NTD are summarized in Table 42.2.
MRI characteristics of the fetal tethered spinal cord: a comparative study
Published in International Journal of Neuroscience, 2022
Yan Sun, Gang Ning, Xuesheng Li, Haibo Qu, Jiangang Zeng
Many classifications for TCS have been discussed; however, due to its complex performance and uncertain mechanism, there is currently no unified method to classify TCS. Several classifications for adults with TCS have been proposed previously [11,17,20]. In 2019, Shang et al. divided children with TCS into five types after analyzing 326 children with TCS, including tight FT, lipo-myelomeningocele, lipomatous malformation, postoperative adhesions, and split cord malformation [12]. In our study, meningomyelocele, meningocele, lipoma, dermal sinus, tight FT, and patients secondary to surgery were also found in both fetuses and children with TCS, while split cord malformation was not found due to the small study population. Lipomatous malformation was the most common concomitant malformation in child patients (50%, 10/20), which was similar to Shang’s research (38%) [12]. Meningomyelocele and meningocele accounted for a greater proportion of fetal TCS cases.
Could Lumbar Lordosis Angle Be A Predictor of Functionality in Children with Spina Bifida? A Cross-Section Study
Published in Developmental Neurorehabilitation, 2021
Spina bifida (SB) is defined as a congenitally defect in which the neural tube does not close properly. It is observed at a global rate of 3.89 cases per 10 000 live births.1 Subtypes of SB are classified according to the coverage of the lesion: a closed SB is covered by skin and an open SB is not covered by skin.2 In meningomyelocele (MMS), one of the subtypes of open SB, the posterior part of the vertebrae forming the spine does not develop, and the membranes surrounding the spinal cord, cerebrospinal fluid, nerves, and dysplastic spinal cord overflow through this opening.1,2 MMS is generally observed at the lumbar and sacral levels.3 Issues associated with SB are numerous and include (a) muscle strength losses and associated paralysis, (b) sensory problems, (c) intestinal, bladder, and kidney problems, (d) congenital deformities (kyphosis, scoliosis, equines, etc.), (e) decreased endurance, balance and mobility disorders, (f) disruption of the walking pattern, and (g) sexual dysfunction.3–5 Other problems in SB patients include hydrocephalus, Chiari II malformation, and tethered cord syndrome.6,7
Limb girdle muscle dystrophy and caesarian delivery: Anesthetic management and brief review of literature
Published in Egyptian Journal of Anaesthesia, 2018
Sumit Soni, Amarjyoti Hazarika, Balbir Kumar
A 28 yr old parturient was referred to our hospital with bad obstetric history (BOH). She had her first spontaneous conception 9 years back and spontaneous bleeding per vaginam at 4th month of pregnancy with complete abortion. During her second spontaneous conception, 8 years back, she had spontaneous bleeding per vaginam at 5th month of pregnancy with complete abortion. The third spontaneous conception was 7 years back with IUFD at 7th month of gestation. Fourth spontaneous conception was 3 years back with no fetal cardiac activity at 4th month of gestation. Two years back she had her fifth spontaneous conception. At 5th month of gestation, fetal congenital malformation was detected. At 33 + 6wks of gestation, preterm vaginal delivery was done and a 2.18 kg baby was delivered which had an open meningomyelocele and did not survive. During the present pregnancy she was under regular follow up. She was planned for elective caesarian section in view of transverse lie of fetus.