Spina bifida is a birth defect that occurs due to disruption of the formation of the neural tube during the baby's time in the womb. This causes a gap in the vertebrae to appear.
The nervous system develops from a plate of cells along the backbone of the embryo. In the first 1 month of pregnancy, the ends of these discs bend, close, and form the neural tube.
Over time, this neural tube will develop into the brain and spinal cord. If this process is disrupted, neural tube defects can occur.
Spina bifida is the most common type of neural tube defect. characterized by several fetal vertebrae that do not close completely and create gaps.
Types of Spina Bifida
Spina bifida is 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. This type generally does not affect the work of the nerves so that its appearance is rarely noticed by the sufferer.
Meningocele is spina bifida with a gap in the larger vertebrae. In this condition, the protective covering of the spinal cord sticks out of the gap, forming a pouch on the baby's back.
The sac that exits through the gap in the spinal column is usually filled with spinal fluid without nerve fibers. Meningocele sufferers may not feel any particular complaints.
Myelomeningocele is the most severe type of spina bifida. In this condition, the sac that emerges from the spinal fissure is filled with fluid and some of the spinal nerves. Complaints that arise will depend on the location and level of damage to the spinal cord.
In more severe cases, there may be complete paralysis of both legs, and difficulty holding urine ( urinary incontinence ) or defecating .
Causes of Spina Bifida
Spina bifida is caused by a neural tube that doesn't develop or close completely during pregnancy. Even so, it is not known exactly why this can happen.
There are several factors that are thought to increase the risk of a mother giving birth to a baby with spina bifida, including:
- Have a family history of spina bifida
- Have a history of taking anti-seizure drugs, such as valproic acid
- Experiencing a deficiency of folic acid , which is a vitamin that plays an important role in fetal development
- Have diabetes or obesity
- Suffer from certain conditions, such as Down syndrome or Edward syndrome
Symptoms of Spina Bifida
Spina bifida symptoms vary, depending on the type. In newborns who have spina bifida occulta, there is a tuft of hair on the back, or there is a small indentation (dimple) in the lower back.
Meanwhile, in meningocele and myelomeningocele, there is a pouch that sticks out on the baby's back. In babies with meningocele, this sac has a thin layer of skin. Whereas in myeomeningocele, the sac does not have a layer of skin so that the fluid and nerve fibers in it can be seen.
Apart from the pouch on the baby's back, newborns with myelomeningocele can also experience a number of the following symptoms:
- Unable to move his limbs at all
- Abnormal shape of the legs, hips or spine
- Urinary disorders
When to see a doctor
Do routine checks to the doctor during pregnancy. Be sure to seek advice and tell your doctor about your medical history, as well as any medications, vitamins and supplements you need or are taking while pregnant.
Have your baby checked by the doctor on the 2nd and 3rd day after birth and every 1–2 months thereafter until he is 2 years old. The goal is to monitor the baby's growth and development process as well as detect any disturbances that may occur.
In newborns showing the above symptoms, the doctor will immediately provide treatment.
Diagnosis Spina Bifida
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 doctors determine spina bifida or birth defects during pregnancy, namely:
Blood test The
doctor will check the levels of AFP ( alpha-fetoprotein ), which is a protein produced by the fetus and contained in the mother's blood. High AFP levels in the blood of pregnant women can be a sign that the fetus is at risk for neural tube defects, such as spina bifida.
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, such as a vertebral gap that is too wide or a lump in the spine.
Amniocentesis is a procedure for taking a sample of amniotic fluid to assess AFP levels. High AFP levels indicate a tear in the skin around the baby's sac. This could be a sign of spina bifida or another birth defect.
Detection after the baby is born
Sometimes, spina bifida is detected after the baby is born. This can happen if the pregnant woman does not routinely undergo prenatal checks, or if no abnormality is seen in the fetal spine during an ultrasound examination.
Examination of newborns can be done by looking directly at the symptoms. Furthermore, to confirm the diagnosis and severity of the condition, the doctor will scan the baby with an X-ray or MRI .
Especially for spina bifida occulta, this condition may not be recognized until childhood, even adulthood. This condition is generally only realized when the patient has an X-ray or scan for certain medical reasons.
Treatment of Spina Bifida
Spina bifida treatment aims to minimize the risk of complications and improve the quality of life for sufferers. Surgery is the main option for treating spina bifida. This action can be done before or after the baby is born. Here's the explanation:
Operation before the baby is born
This operation can be done before the 26th week of gestation or around the 19th to the 25th week. The operation is performed by dissecting the uterus, followed by closing the gaps in the nerves and spine of the fetus.
This procedure is considered to have the lowest risk of birth defects. However, this operation carries a risk of causing the baby to be born prematurely. Therefore, discuss it with your doctor before undergoing this action.
Operations after the baby is born
This procedure is carried out within 72 hours after the baby is born. The operation is performed by returning the spinal fluid, nerves and tissues to their proper place. After that, the doctor will close the gap in the vertebrae.
In myelomeningocele, shunt placement is possible. A shunt is a tube-shaped channel installed in the brain to drain cerebrospinal fluid to other locations in the body, such as the spine. The goal is to prevent fluid buildup in the brain (hydrocephalus).
Care after surgery
Postoperative follow-up care is usually also needed by spina bifida patients, especially in cases of myelomeningocele. This is because nerve damage has already occurred and cannot be cured. This treatment includes:
- Therapy to help patients adapt to everyday life, for example with occupational therapy and physiotherapy
- Use of mobility aids, such as a cane or wheelchair, to facilitate the patient's activities
- Handling disorders in the urinary tract and digestive tract, both with drugs and surgery
- Spinal nerve surgery, to unravel 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, 90% of babies with spina bifida can grow and live well into adulthood.
Spina Bifida Complications
Mild levels of spina bifida, such as spina bifida occulta, generally do not cause complications or only cause mild physical disability. However, spina bifida which is quite severe and is not treated immediately can cause complications in the form of:
- Weak muscles to paralysis
- Bone defects, including scoliosis , dislocated hips, shortening of muscles, and deformities of the joints
- Fluid buildup in the cavities of the brain ( hydrocephalus )
- Disorders of bowel movement
- Urination and defecation disorders
- Structural abnormalities of the brain or skull, such as type 2 Chiari malformation
- Inflammation of the lining of the brain ( meningitis )
- study delay
Prevention of Spina Bifida
The main step to avoid the occurrence of spina bifida is to meet the needs of folic acid, both when planning a pregnancy and during pregnancy. The recommended dose of folic acid for pregnant women is 600 micrograms (mcg) per day.
Pregnant women are advised to increase their consumption of food sources of folic acid , such as poultry, seafood, eggs, broccoli, spinach, oranges, avocados, papaya and nuts. In addition, pregnant women also need to take folic acid supplements , according to the doctor's advice.
In addition, also take a number of preventive steps below:
- Carry out routine checks to the doctor when planning pregnancy and during pregnancy
- Conduct regular health checks when diagnosed with diabetes
- Undergo a weight loss program if suffering from obesity