1. Diagnostic Tests
1.1. Alpha-Fetalprotein Test: high levels of AFP in mother's bloodstream from baby indicates a neural tube defect
1.1.1. Ultrasounds during pregnancy
1.1.2. Aminocentesis: healthcare provider takes a small amniotic fluid sample -> if high levels of AFP are shown, baby may have a neural tube defect
1.1.3. Spina Bifida may be diagnosed after birth by CT, Xray, or MRI if the baby has a dimple or hairy patch on his/her back (CDC.gov, 2019).
2. Common Findings
2.1. Spina Bifida is a "protrusion of spinal tissue through the vertebral column and consists of meninges, the spinal cord, and nerve roots"(Jorde, 2019, p. 163)
2.1.1. Can cause secondary hydrocephalus, which may affect intellectual ability. Club feet, muscle weakness, paralysis, and loss of sphincter control may also be complications (Jorde, 2019).
2.2. The three common types of Spina Bifida are: *Spina Bifida Occulta (small gap in spine, but no sac or opening on the baby's back), *Meningocele (a sac of fluid present on the back without spinal cord), and *Myelomeningocele (sac of fluid that comes through opening in baby's back and cosists of nerves and part of the spinal cord) (Cdc.gov, 2019 ).
3. Treatments
3.1. A major preventative treatment is to have reproductive women take 0.4mg of folic acid as a supplement. In addition to this many foods in the U.S. have also added folic acid into their ingredients to prevent deficiency.
3.1.1. Depending on severity of Spina Bifida either open or closed, treatment varies
3.1.1.1. For open Spina Bifidas such as myelomeningoceles, prenatal surgery may be done in order to close the baby's spine before birth. Surgery can be a treatment as well after birth to minimize damage to nerves and prevent infection (Cdc.gov, 2019).
3.1.1.2. Other treatments consist of treating complications derived from Spina Bifidas such as mobility aids & physical therapy, bowel and bladder management (ultrasounds, scans, surgery, catheter to empty bladder, oral medications etc.), shunt placement for hydrocephalus (Cdc. gov, 2019)
4. Pathophysiologic etiology
4.1. Spina Bifida is a common neural tube defect that is caused when the neural tube (a structure that begins to form the central nervous system) fails to close at 4 weeks pregnancy. It may also occur if the neural tube reopens during pregnancy (Jorde, 2019).
5. Causative Factors & Risk Factors
5.1. Can be caused by genetic and environmental factors, however not all causes are known
5.1.1. Women who have uncontrolled diabetes and are obese may also have an increased risk of neural tube defects
5.2. A major risk factor is folic acid deficiency at time of conception. According to (Jorde, 2019), 50-70% of neural tube defects can be avoided by adding folic acid supplements to diet.
5.3. A genetic response to how mothers respond to folic acid can also determine risk of neural tube defects. Example: some may be folic acid deficient and there are no neural tube defects while women who take adequate amounts of folic acid still have babies with defects (Jorde, 2019).
5.3.1. Incidence of neural tube defects increases if older siblings were diagnosed with Spina Bifida or other neural tube defects