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Prenatal ultrasound evaluation of segmental level of neurological lesion in fetuses with myelomeningocele: development of a new technique.
- Source :
-
Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology [Ultrasound Obstet Gynecol] 2016 Feb; Vol. 47 (2), pp. 162-7. Date of Electronic Publication: 2016 Jan 13. - Publication Year :
- 2016
-
Abstract
- Objectives: To report our preliminary experience in the use of prenatal ultrasound examination to assess lower-limb movements in fetuses with myelomeningocele. We aimed to determine the accuracy of this method to establish the segmental level of neurological lesion, as this is the best known predictor of the future ability to walk.<br />Methods: This was a preliminary, observational study including fetuses with myelomeningocele operated on prenatally. The patterns of movements present and absent in the affected fetuses' lower limbs were evaluated systematically by ultrasound examination. According to the known nerve function associated with each muscle group, the segmental level of neurological lesion was established before birth. The agreement for the segmental levels assigned, between the prenatal ultrasound technique and the classical neurological clinical examination after birth (gold standard), was tested using the weighed kappa (wκ) index.<br />Results: Seventy-one fetuses with myelomeningocele were evaluated at the Hospital Universitari Vall d'Hebron. After counseling, the parents opted for prenatal surgery (26 cases), termination of pregnancy (43 cases) or postnatal repair (two cases). Five patients did not fulfil the inclusion criteria for prenatal surgery and three were excluded after birth. In the 18 fetuses that underwent surgery and were analyzed, the agreement between prenatal and postnatal segmental levels assigned was 91.7% for the right limb (wκ = 0.80) and 88.9% for the left limb (wκ = 0.73).<br />Conclusions: The agreement found between prenatal and postnatal assignment of level of lesion in this preliminary study suggests that neurological sonographic evaluation is feasible before birth. This may provide accurate individualized information about the motor function and future ambulation prognosis of fetuses with myelomeningocele.<br /> (Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.)
- Subjects :
- Adult
Female
Gait Disorders, Neurologic embryology
Gait Disorders, Neurologic etiology
Gestational Age
Humans
Lower Extremity diagnostic imaging
Lower Extremity embryology
Meningomyelocele complications
Meningomyelocele embryology
Predictive Value of Tests
Pregnancy
Prognosis
Reproducibility of Results
Fetal Movement
Fetus physiopathology
Gait Disorders, Neurologic diagnostic imaging
Meningomyelocele diagnostic imaging
Ultrasonography, Prenatal methods
Subjects
Details
- Language :
- English
- ISSN :
- 1469-0705
- Volume :
- 47
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology
- Publication Type :
- Academic Journal
- Accession number :
- 26306897
- Full Text :
- https://doi.org/10.1002/uog.15732