Nursing 209

N209: Reproductive Health Study Guide o Neurological evaluation of muscle weakness patterns o Imaging: MRI and ultrasound to examine muscle quality

In the embryonic stage, the neural plate is formed ; the neural tube is formed when the edges of that plate curl, forming the brain and spinal cord by day 28 of pregnancy • Also known as “cleft spine” and is an incomplete development of brain, spinal cord, and/or meninges • Four types: Occult, closed NTDs, meningocele, and myelomeningocele • Most common form is occulta, where one or more vertebrae are malformed (mildest form and is present in 10-20% of general population); usually causes no symptoms or disability (covered by skin) • In closed NTDs, there are spinal cord malformations in fat, bone, or meninges; usually no or few symptoms, but some closed NTDs can result in incomplete paralysis with urinary or bowel problems • Meningocele: Protrusion of spinal fluid and meninges through abnormal vertebrae; may or may not be covered with skin and signs and symptoms are same as with closed NTDs • Myelomeningocele: The most common form o Spinal cord and neural elements are exposed via an opening in the spine o Complete or partial paralysis below the opening with bowel and bladder dysfunction o Exact cause in unknown, but thought to be genetic along with nutritional and environmental factors o Inadequate folic acid intake is thought to be key factor in NTDs o Affects 1500-3000 births in the U.S.; risk is five times higher in women who have spina bifida or who have had a history of NTD with past pregnancy o More common with obesity, poorly controlled diabetes, and anti-seizure meds o Signs and symptoms: Closed NTDs often present with a small dimple, tuft of hair, or birthmark at the malformation site • In meningocele and myelomeningocele, the fluid-filled sac protrudes from the spinal canal • In meningocele, it may be covered with skin • In myelomeningocele the sac and spinal cord are exposed • Diagnosis: Usually made prenatally via elevated AFP or NIPT; can also be noted on anatomy ultrasound and confirmed with amniocentesis • Treatment: No cure o Surgery to close the defect is performed with myelomeningocele to prevent infection and further damage in the first few days of life o Some centers may perform fetal surgery in utero (remains experimental due to risks to both mother and baby)

Spina Bifida •

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