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Perinatal Management of Meningomyelocele

Departments of Obstetrics and Gynecology, Neurosurgery, and Neurology, Yale-New Haven Medical Center, New Haven, Connecticut.

During a 24-month period, nine neonates with a meningo-myelocele were delivered. Of these, four meningomyeloceles were detected antenatally with ultrasound during the third trimester. Sonographic diagnosis was based upon a discontinuity in the fetal spine and the presence of a protruding sac. Obstetric management included serial sonography until fetal pulmonic maturity was established, and subsequent low transverse cesarean section. A method of atraumatic abdominal delivery is described. Neonatal management consisted of early closure of the spinal defect and appropriate shunting of hydrocephalus. A team approach to the perinatal management of meningomyelocele is recommended for optimal outcome.

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