Prenatal screening
Prenatal screening is recommended for pregnant women to detect not only NTD but also to screen for Down's syndrome and related disorders. A simple blood test known as the quad screen is done in the second trimester.
The elements of the test include alpha feto-protein (AFP), human chorionic gonadotropin (HCG), estriol, and inhibin A. Elevated levels of AFP suggest that a NTD is present and further testing is indicated. This includes high-resolution ultrasounds and amniocentesis. Ultrasound can detect a splaying of the pedicles and the classic “lemon and banana signs.” The lemon sign relates to the shape of the head, and the banana sign is related to herniation of the cerebellar vermis through the foramen magnum, which appears to be banana-shaped. What is critical about prenatal diagnosis is the ability to plan ahead. Fetal surgery is available for families on a research basis through the Mothers of Meningomyelocele (MOM) program. The optimal delivery options should include cesarean section in a high-risk center with a neurosurgeon available.
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