Multidisciplinary management of fetal neural tube defects: clinical case report

Abstract

Abstract. Background: Neural tube defects, particularly myelomeningocele, are among the most severe congenital anomalies affecting the central nervous system. Early diagnosis through antenatal screening allows for optimized delivery planning and immediate intervention. However, in low-resource settings, lack of prenatal care often results in delayed diagnosis and management. Clinical Case Description: We present the case of a 35-year-old woman – gravida 4, para 4, who received no antenatal care and ultrasound examination throughout her pregnancy. The patient presented at term in spontaneous labor and underwent cesarean section due to obstructed labor. The neonate was delivered with a lumbosacral myelomeningocele measuring approximately 6 cm in diameter, with exposed neural tissue and cerebrospinal fluid leakage. Neurological examination revealed lower limb paralysis and neurogenic bladder. Imaging study confirmed the diagnosis, with no associated hydrocephalus. The neonate underwent early surgical repair within 48 hours of birth, followed by comprehensive neonatal care and multidisciplinary follow-up. Postoperative recovery was uncomplicated. The surgical site healed well, although neurological deficits persisted. The infant was discharged on day 12 with a structured follow-up plan involving pediatric neurology, urology, and physiotherapy. Long-term management was initiated to address functional and developmental needs. Conclusions: This case highlights the critical importance of prenatal care, including folic acid supplementation and routine ultrasonography, in the prevention and early detection of neural tube defects. Even in the absence of prenatal diagnosis, favorable outcomes can be achieved through timely surgical intervention and coordinated multidisciplinary care. The case underscores the dual necessity of preventive public health strategies and responsive clinical management in addressing congenital anomalies in resource-limited settings.