0 Neural Tube defects ( NTD )


Neural Tube defects ( NTD )

  • Anterior - normally closes at 25 days
  • Posterior - normally closes at 27 days

NTD due to failure of closure.
  • Anterior nonclosure - Ancephalocele , Encephalocele
  • Posterior nonclosure - Spina Bifida , Meningocele , Meningomyelocele

Risk factor :
  1. Maternal folic acid deficiency (Most important)
  2. Maternal Zn deficiency
  3. Materanl Malnutrition
  4. Maternal Alcohol , Diabetes , Radiation
  5. Maternal Anticonvulsan (Valproate , phenytoin)

Thus Start folic acid 1 month before conception to 3 months after conception. -> 400microg

To prevent recurrence : give 4mg Folic acid (i.e 10 times)

Meningocele : Herniation of meninges

Meningomyelocele : Herniation of meninges + nerve roots

if Lumbosacral Meningomyelocele - Complications
  1. Paraplegia /parasis
  2. Posterior dislocation of hip
  3. Bowel and bladder incontinence
  4. Do MRI head - because 80% will have obstructive hydrocephalus , because of Arnold Chiari type 2 malformation.

Encephalocele : Herniation of brain tissue. 
Occipital is more common than frontal.

Earliest Congenital anomaly that can be diagnosed by USG : Anencephaly (at 10-11 wks)

Tests for NTD
  1. Amniocentesis : Acetyl cholinesterase and Alpha feto protein
  2. Maternal Serum : AFP (MSAFP)

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