Termination of pregnancy after prenatal diagnosis of spina bifida: a German perspective.

Abstract

To analyze fetal cases with spina bifida undergoing termination of pregnancy according to chromosomal analysis and further diagnosed sonographic findings. Retrospective analysis of cases with spina bifida leading to termination of pregnancy in a tertiary referral center from 2002 to 2011. In the study period, 246 cases of spina bifida were diagnosed in our center and 157 parents chose termination of pregnancy. The time of diagnosis was on average 2days before the first presentation at our department (22+3, range: 12+3 - 33+3weeks of gestation). Among 157 pregnancies with spina bifida and termination of pregnancy, further malformations could be detected in 46 (29.3%) cases. An abnormal karyotype could be found in 13 (18.1%). Severe ventriculomegaly or mild/moderate ventriculomegaly was present in 109 (69.4%) and 29 (18.5%) of the cases, respectively, while banana sign was detectable in 153 cases (97.5%). In the majority, the upper lesion level was lumbar (71.3%). In 67 cases (42.7%), termination of pregnancy took place in or after the 24th week of gestation. Direct and indirect signs of spina bifida were detectable in nearly all cases independent of the gestational age. Therefore, the diagnosis could have been made in all cases with late termination. Implementation of a uniform prenatal care including first-trimester scan with potential signs for open spina bifida and second-trimester anomaly scan with indirect intracranial findings and direct detection of spinal lesion could lead to an earlier diagnosis and help to reduce late termination of pregnancy in neural tube defects.