Talipes And Spina Bifida

Question 1

What is the incidence of talipes?

Answer 1

1:1000

Question 2

What is the USS appearance of talipes?

Answer 2

Sole of foot is not perpendicular to the lower leg bones

The foot appears medially rotated/deviated

Question 3

What can talipes be associated with?

Answer 3

Aneuploidy - T18
Oligohydramnios
NTD
Connective tissue disorders - ehlers danlos and marfans
Skeletal and neuromuscular abnormalities

50% is isolated

Question 4

What is the prognosis of talipes?

Answer 4

90% good long-term function by manipulation and serial application of casts

10% need surgery

3% need more than one surgery

Question 5

What is the recurrence rate of talipes?

Answer 5

One sibling affected = 3%

Parent and one sibling affected = 25%

Question 6

What is the incidence of spina bifida?

Answer 6

1:1000

Question 7

Taking folic acid reduces incidence of spina bifida by what %

Answer 7

70%

Question 8

What are risk factors for NTD

Answer 8

Personal / family history
Reduced folate absorption - insulin, anticonvulsants, infertility treatment, Vitamin A
Diabetes
Obesity
Increased body temperature in first few weeks of pregnancy - fever, hot tub

Question 9

What are the three types of spina bifida?

Answer 9

Spina bifida occulta
Spina bifida meningocoele
Spina bifida myelomeningocoele

Question 10

What is a Chairi malformation?

Answer 10

Where there is a small posterior fossa and the brainstem, cerebellar vermis and tonsils herniate through the foramen magnum.

Can cause problems with breathing and swallowing.

Question 11

What is the management of spina bifida myelomeningocoele

Answer 11

Antenatal

• referral to MFM, review and detailed USS
• karyotype testing
• offer TOP or continuation of pregnancy
• counselling with NICU
• USS every 4 weeks to assess for ventriculomegaly, kyphoscoliosis, talipes

Intrapartum
- El LSCS to minimise damage to spinal cord (not required for spina bifida occulta)

Postpartum

• Keep sac outside the body moist
• antibiotics to reduce risk of meningitis
• cranial USS, CT, MRI, kidney function tests
• if hydrocephalus, VP shunt
• surgery to close defect within 24-48 hours
• physiotherapist
• may need urinary catheter

Question 12

What are USS findings of spina bifida

Answer 12

Myelomeningocoele
Arnold Chiari malformation 
Hydrocephalus
Lemon sign: frontal bone scalloping
Banana sign: obliteration of cisterns Magna with either absent cerebellum or abnormal anterior curvature of the cerebellar hemispheres

Talipes

Question 13

What is the prognosis of spina bifida?

Answer 13

25% stillborn
5 year mortality rate 35%
20% die in first year of life

Question 14

What is the recurrence rate of NTD

Answer 14

Affected parent OR one sibling: 4%

Two affected siblings: 10%

Question 15

What maternal blood test can help detect spina bifida?

What is the sensitivity?

Answer 15

Maternal serum alpha fetoprotein taken 16-18 weeks.
Abnormal >2 MoM.
Detects 80% of open NTDs and 90% of anencephaly.