Abstract
ObjectiveTo determine the feasibility of visualizing markers of open spina bifida (OSB) in the first trimester in a simple, fast manner without the use of biometrics. To conduct biometrics of the different structures of the hindbrain, establishing changes in these structures depending on gestational age. Material and methodsWe conducted a prospective study in 362 pregnant women from February-December 2013. The women were at 11-13+6 weeks of pregnancy (crl: 45-84mm.). Vaginal and abdominal examinations were carried out. The fetus was viewed in mid-sagittal plane, rear back, with visualization of the reference markers for nuchal translucency (NT). View of 4 echogenic parallel lines in the hindbrain: 1st. Sphenoid bone rear ridge. 2nd Rear ridge of the anterior brainstem of the forth ventricle. 3rd Fourth ventricle choroid plexus. 4th Occipital bone. These lines delimit 3 echonegative spaces of similar echogenicity: 1st Brainstem. 2nd Forth ventricle. 3rd Cisterna magna. Their biometries and the brainstem/brainstem- occipital bone ratio were obtained. ResultsThe mean crl was 64.65mm (range 46.97-84). It was possible to obtain a mid-sagittal plane and visualize 4 lines–three spaces and a biometry in 98.6%. The biometrics were in agreement with those reported in the literature; they increased with gestational age and their thickness decreased. The ratio was constant. None of the fetuses evaluated in the 20th week ultrasonography and/or at birth had OSB. We confirm the usefulness of obtaining this view after finishing the study, in a case in which we only identified 3 lines–2 spaces, which prompted us to focus on the spine and diagnose OSB at a lumbosacral level. ConclusionsFurther studies are required, but we suggest including simple visualization of 4 lines–3 spaces as a routine step in OSB screening. If this visualization is abnormal or questionable, biometrics and a more meticulous cranio-spinal examination should be carried out taking into account the option of ultrasonography.
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