Spina bifida is a birth defect that occurs due to disruption of the formation of the neural tube during the baby's womb. This causes the appearance of gaps in the vertebrae.
The nervous system develops from a disk of cells along the back of the embryo. In the first month of pregnancy, the ends of these discs curl, close, and form the neural tube. Over time, this neural tube will develop into the brain and the nervous system in the spine.
When this process is disrupted, neural tube defects (neural tube defects) could occur. Spina bifida is one of the most common types of neural tube defects, in which some of the vertebrae of the fetus do not close completely and create gaps.
Various Types of Spina Bifida
Spina bifida is rare. This disease can be divided into three groups based on the size of the gap formed, namely:
Spina bifida occulta
Spina bifida occulta is the mildest type of spina bifida because the gaps that appear in the vertebrae are small. Spina bifida generally does not affect the work of the nerves so that its appearance is rarely noticed by sufferers.
Meningocele
Meningocele is spina bifida with clefts in the larger vertebrae. In this condition, the protective membrane of the spinal cord sticks out of the gap, forming a pouch on the baby's back.
The sac that comes out through the gap in the vertebral column usually contains spinal cord fluid without nerve fibers, so the sufferer may not feel certain complaints.
Myelomeningocele
Myelomeningocele is the most severe type of spina bifida. In this condition, the sac that emerges from the spinal cleft contains fluid and part of the spinal cord. Complaints and symptoms that appear will depend on the location and level of spinal cord damage.
If the spinal cord that regulates the function of urination is damaged, urination disorders may appear. In more severe cases there may be complete weakness or paralysis of the limbs accompanied by urinary disturbances.
Symptoms of Spina Bifida
Symptoms of spina bifida vary, depending on the type. Spina bifida occulta rarely causes symptoms because it does not involve the spinal cord. Signs of spina bifida occulta are visible tufts of hair on the newborn's back, or small dimples in the newborn's lower back.
In contrast to spina bifida occulta, the appearance of meningocele and myelomeningocele is characterized by the presence of a pouch sticking out of the baby's back. In meningocele, this sac has a thin layer of skin. In myomeningocele, this sac can appear without a layer of skin so that the fluid and nerve fibers in it can be seen immediately.
In addition to the presence of a pouch on the baby's back, newborns with myelomeningocele may also experience the following symptoms:
- Couldn't move his legs at all.
- Abnormal shape of the legs, hips, or spine.
- Having seizures.
- Having trouble urinating.
When to go to the doctor
If you find a newborn with a number of the symptoms mentioned above, the doctor will immediately provide treatment.
You are also advised to have regular check-ups with your doctor when planning to become pregnant and during pregnancy. Be sure to seek advice and tell your doctor about your medical history, medications, vitamins, and supplements you need or are taking while pregnant.
Do regular checkups to the doctor from birth to childhood. Babies need to be checked again by the doctor on the 3rd and 5th day after birth and every 1-2 months thereafter until they are 2 years old. This can help monitor the baby's growth and development as well as detect disorders that may occur.
Causes of Spina Bifida
Spina bifida is caused by the neural tube being underdeveloped or not closing properly during pregnancy. Even so, it is not known exactly why this can happen.
There are several factors that are considered to increase the risk of a mother giving birth to a baby with spina bifida, including:
- Have a folic acid deficiency. Folic acid is a very important vitamin for fetal development.
- Have a family history of spina bifida.
- Have a history of taking anti-seizure medications, such as valproic acid.
- Suffer from diabetes or obesity.
- Experiencing hyperthermia in the early weeks of pregnancy.
Spina Bifida Diagnosis
Spina bifida can be detected during pregnancy or after the baby is born. Ways that can be done include:
Diagnosis during pregnancy
There are a number of tests that can help your doctor confirm spina bifida or birth defects during pregnancy, including:
- blood test
Doctors can check the level of AFP (alpha-fetoprotein) contained in the blood of pregnant women. AFP is a protein produced by the fetus. High levels of AFP in the blood of pregnant women can indicate the fetus has the potential to have neural tube defects, such as spina bifida.
- ultrasound (ultrasonography)
A visual scan of the fetus via ultrasound can help detect spina bifida. Through this test, the doctor can see structural abnormalities in the fetus's body. For example, the gap in the vertebrae is too wide or there is a lump in the spine.
- Amniocentesis
Amniocentesis is a procedure for taking a sample of the amniotic fluid. In this test, AFP levels will be assessed. High AFP levels indicate a tear in the skin around the baby's sac. This could be a sign of spina bifida or other birth defects.
Detection after the baby is born
Sometimes, spina bifida is only detected after the baby is born. Maybe because pregnant women do not routinely undergo prenatal care or because there are no abnormalities in the fetal spine during an ultrasound examination.
Examination of babies who have been born can be done by looking directly at the symptoms. Then, to confirm the diagnosis and the severity of the condition, a scan can be performed on the baby, for example with X-rays or MRI.
Especially for spina bifida occulta, this condition may go unnoticed until childhood, even adulthood. This situation is generally only realized when the patient performs X-rays or other scans for certain medical reasons.
Spina Bifida Treatment
Spina bifida treatment aims to minimize the risk of complications and improve the sufferer's quality of life. Surgery is the first choice for treating spina bifida. This handling step can be done before or after the baby is born. Here's the explanation:
Surgery before the baby is born
This operation needs to be done before the 26th week of pregnancy. The operation is carried out by performing a uterine surgery process followed by closing the gap in the nerves and spinal cord of the fetus.
This method of handling is considered to have the lowest potential for birth defects. Even so, this operation has the risk of causing the baby to be born prematurely. To be safe, discuss carefully with your doctor before doing this procedure.
Surgery after the baby is born
The operation needs to be done within 48 hours of the baby being born. The operation is performed by returning spinal fluid, nerves, and tissues to their proper place, then closing the gap in the vertebral column.
In myelomeningocele, insertion shunt possible to do. Shunt are tube-shaped tubes that are placed in the brain to drain and direct cerebrospinal fluid to other locations in the body, such as the spine. This aims to prevent the buildup of fluid in the brain (hydrocephalus).
Care after surgery
Postoperative follow-up care is usually also needed by patients with spina bifida, especially in myelomeningocele. This is because nerve damage has already occurred and cannot be cured. These treatments include:
- Surgery to return the legs, hips, or spine to their proper position.
- Therapy to help patients adapt to everyday life, for example by occupational therapy and physiotherapy.
- Use of mobility aids, such as canes or wheelchairs, to facilitate the patient's activities.
- Handling disorders of the urinary tract and digestive tract either with drugs or surgery.
- Spinal cord surgery to untangle the spinal nerve endings that are wrapped around the spinal area.
The chances of successful treatment of spina bifida are very high. According to research, about 90% of babies with spina bifida can grow and live well into adulthood.
Spina Bifida Complications
Mild spina bifida, such as spina bifida occulta, generally causes no complications or causes only mild physical disability. However, spina bifida is quite severe and not treated immediately can cause complications such as:
- Muscle weakness to paralysis.
- Bone defects, including scoliosis, hip dislocation, shortening of muscle length, and joint deformities.
- Disorders and problems with bowel movements, and the process of urination.
- Accumulation of fluid in the cavity of the brain (hydrocephalus).
- Structural abnormalities of the brain or skull, such as Chiari malformation type 2.
- Infection of the tissue that lines the brain (meningitis).
- Learning delay.
Spina Bifida Prevention
The main step to prevent spina bifida is getting enough folic acid, especially when planning to become pregnant and during pregnancy. The recommended dose of folic acid is 400 micrograms per day.
Pregnant women can meet this need by taking folic acid supplements and increasing the consumption of foods rich in this vitamin, such as beans, egg yolks, broccoli, spinach, pasta, rice, and bread.
In addition, also take a number of preventive steps below:
- Have regular check-ups with the doctor when planning a pregnancy and during pregnancy.
- Conduct regular health checks if diagnosed with diabetes and obesity.
- Avoid activities that overheat during pregnancy, such as hot baths and saunas.