A girl at 39 weeks gestation is born via vaginal delivery to a 25-year-old primigravida. The patient's mother has no significant medical history and took no medications during pregnancy, but the parents moved several times, making prenatal care inconsistent. Family history is notable for a paternal cousin with cystic fibrosis and a maternal aunt with iron-deficiency anemia. Ultrasonography performed at 35 weeks gestation by the mother's current health care provider demonstrated a cystic sac over the infant's lumbar spine. Group B Streptococcus screening at 36 weeks gestation was negative. At birth, the infant's Apgar scores are 7 and 8, with a birth weight of 3.5 kg (7 lb 11 oz). Physical examination shows a red sac with an overlying membrane over the infant's lumbar spine. The suspected diagnosis is discussed with the infant's parents. Which of the following is the most common complication of this patient's condition?

Question

A girl at 39 weeks gestation is born via vaginal delivery to a 25-year-old primigravida.  The patient's mother has no significant medical history and took no medications during pregnancy, but the parents moved several times, making prenatal care inconsistent.  Family history is notable for a paternal cousin with cystic fibrosis and a maternal aunt with iron-deficiency anemia.  Ultrasonography performed at 35 weeks gestation by the mother's current health care provider demonstrated a cystic sac over the infant's lumbar spine.  Group B Streptococcus screening at 36 weeks gestation was negative.  At birth, the infant's Apgar scores are 7 and 8, with a birth weight of 3.5 kg (7 lb 11 oz).  Physical examination shows a red sac with an overlying membrane over the infant's lumbar spine.  The suspected diagnosis is discussed with the infant's parents.  Which of the following is the most common complication of this patient's condition?

Quizplus · Accepted Answer

Explanation: 11ec2b69_bfff_deae_8f63_b94e939b853d_MD0005_00 This patient has a myelomeningocele, or spina bifida, which is a defect of the lower vertebral column that exposes the spinal cord and meninges. The most common neural tube defect (NTD), spina bifida is caused by failure of the caudal neuropore to close properly during fetal development. Most NTDs result from folate deficiency during pregnancy; other risk factors include pregestational diabetes, maternal fever in the first trimester, maternal obesity, and genetic factors. Elevated alpha-fetoprotein on maternal screening is suspicious for NTD, and the diagnosis is confirmed on prenatal ultrasound. Immediately after birth, the defect is wrapped in a moist, sterile dressing and covered with plastic wrap to prevent infection and heat loss. Patients undergo urgent surgical repair, which results in hydrocephalus requiring a ventriculoperitoneal shunt in over half of infants. spina bifida Despite surgical repair, motor, sensory, and autonomic functions below the level of the spinal lesion are typically affected. Neurogenic bladder, presenting with urinary retention/incontinence, recurrent urinary tract infections, and potential renal dysfunction, is almost universal. Treatment with clean intermittent catheterization relieves pressure on the upper urinary tract and helps prevent urinary stasis. Neurogenic bowel is also common, and a scheduled bowel regimen of laxatives, suppositories, and enemas is recommended to treat constipation. (Choice A) Although decubitus ulcers can occur in patients with spina bifida who may be immobile for prolonged periods, they are usually preventable with frequent repositioning. Neurogenic bladder is more common. (Choice B) Feeding difficulties may occur in patients with cerebral palsy due to abnormalities in tone, but they are not common in children with spina bifida. (Choice C) Patients with spina bifida are typically fertile and require counseling on reproductive health. Compared with the general population, these patients carry an increased risk of having a child with spina bifida. (Choice D) Megaloblastic anemia can be caused by folate deficiency; although children with spina bifida are often born to folate-deficient mothers, they are not typically folate deficient. Educational objective: Myelomeningocele, or spina bifida, is a result of the spinal cord and meninges herniating through a defect in the vertebral column. Almost all patients with spina bifida have associated neurogenic bladder due to disruption of spinal cord control of normal urinary function. References: Update on urological management of spina bifida from prenatal diagnosis to adulthood. (http://www.ncbi.nlm.nih.gov/pubmed/25839383)

A Girl at 39 Weeks Gestation Is Born Via Vaginal