Early Ultrasonic Detection of Neural Tube Defects

Objective: Evaluation of early neural tube defects by ultrasound examination. Study Design: Observational study. Material and Methods: Public and private hospitals of Lahore, from October 2011 to January 2014. (Amna Inayat Medical College, Avicenna Medical College, Shaikh Zayed Hospital, Fatima Memorial Hospital, National Hospital, Defence Medical Group). Ultrasound done in public and private centers of Lahore, Pakistan. Routine anomaly scan (18 – 23 weeks gestation) done for 2034 pregnant women to assess the effectiveness of diagnostic ultrasound in the diagnosis of neural tube defects. During the anomaly scan the fetus with neurological defects was recorded separately and followed up. Results: Out of the 2034 pregnant women screened, 27 fetus (.01%) were diagnosed with neural tube defects. Out of these, 4 fetus had anencephaly. Two of the women opted to terminate the pregnancy immediately and the other two mothers opted to continue to term and they delivered stillborns. There were 3 women whose fetus were diagnosed with acrania. Encephalocele was seen in 5 patients. Three had frontal encephaloceles and 2 had posterior encephaloceles. Fourteen cases of spina bifida with associated congenital anomalies were detected. The most common associated anomaly was hydrocephalus (seen in 9 of the fetus), lumbar meningocele (seen in 8 of fetus). Scoliosis (seen in 6 fetus). One patient was diagnosed with hydrocephalus and after birth it was deter-mined to be agenesis of corpus callosum. Conclusion: Ultrasound is a beneficial investigation to make early diagnosis in neural tube defects. Anomaly scan is a routine investigation assisting the neurosurgeon in treatment and prognosis for the fetus. Such cases with neural tube defects should be assessed early and delivered in tertiary care hospitals so that early treatment may be initiated for better prognosis