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Discussion outline by Professor Omar Hasan Kasule for Year 2 PPSD session on 12th March 2008
1.0 BACKGROUND
The neural tube, the embryonic structure that develops into the central nervous system, normally closes by the end of the third week of fetal growth; severe deficits result if it fails to close. Examples of neural tube defects include the absence of brain (anencephaly) and a cyst replacing the cerebellum. The spinal canal or cord may also fail to close up.
Spina bifida is a neural tube defect that varies in severity. In spina bifida occulta there is only X-ray evidence of damage to the spinal cord. The meningocele form of the disorder is characterized by a meningeal pouch that visibly projects through the skin. Spina bifida meningomyelocele is diagnosed when such a pouch contains elements of the spinal cord or nerve roots. Function of the legs and bladder and bowel control is often severely impaired in individuals with spina bifida. Infants with the defect commonly have hydrocephalus as well.
Hydrocephalus, the accumulation of cerebrospinal fluid in the ventricles, or cavities, of the brain, causes progressive enlargement of the head. The condition usually results from a congenital malformation that blocks normal drainage of the fluid. A tube called a shunt is required to drain cerebrospinal fluid from the brain and prevent further expansion of the skull.
2.0 DELIVERY: Before term OR at term?
4.1 Anencephaly
4.2 Spina bifida
4.3 Hydrocephalus
5.0 METHOD OF DELIVERY: vaginal OR Caeserean?
4.1 Anencephaly
4.2 Spina bifida
4.3 Hydrocephalus
6.0 CPR AT BIRTH OF SEVERELY MALFORMED INFANT: GIVE OR WITHHOLD?
4.1 Anencephaly
4.2 Spina bifida
4.3 Hydrocephalus
7.0 LONG TERM SUPPORT OF THE CONGENITALLY MALFORMED