Spina bifida

Latex. Allergy to natural rubber latex is the second most common cause of anaphylaxis during anesthesia in the general population. In children subjected to numerous operations, particularly those suffering from spina bifida, it is the primary cause of anaphylaxis [11]. The relative frequency of allergy to latex has rapidly increased, rising from 0.5% before 1980 to 20% in France in 2002. A low rate has been reported in countries where a strategy aimed to reduce latex exposure was implemented [6]. 

Supplements of 400 Ig/d of folate begun before conception result in a significant reduction in the incidence of neural mbe defects as found in spina bifida. Elevated blood homocysteine is an associated risk factor for atherosclerosis, thrombosis, and hypertension. The condition is due to impaired abihty to form methyl-tetrahydrofolate by methylene-tetrahydrofolate reductase, causing functional folate deficiency and resulting in failure to remethylate homocysteine to methionine. People with the causative abnormal variant of methylene-tetrahydrofolate reductase do not develop hyperhomocysteinemia if they have a relatively high intake of folate, but it is not yet known whether this affects the incidence of cardiovascular disease. 

In these 500 cases, there were 26 culture failures, an Incidence of about 5% Nine women of this group underwent a second aminocentesls, and successful cultures were obtained The other 17, or 3 4% of the total, did not obtain any results, either because of spontaneous abortions prior to the time a second amniocentesis could be performed (In four) or because the family elected not to proceed There were no Instances of severe or significant fetal Injury, although small linear "scars" were noted on four fetuses Three fetuses had abnormalities which were not related to the procedure Itself, Including spina bifida, osteogenesis Imperfecta, and congenital heart disease ... 

Wald, N. J. Brock, D. J. H. and Bonnar, J. "Prenatal Diagnosis of Spina Bifida and Anencephaly by Maternal Serum - Alpha-Fetoprotein Measurement. A Controlled Study". 

The answer is d. (Katzung, pp 411, 1029.) An increased incidence of spina bifida may occur with the use of valproic acid during pregnancy Cardiovascular, orofacial, and digital abnormalities may also occur. The main issue with the use of phenobarbital or primidone (metabolite is phe-nobarbital) for the fetus is neonatal dependence on barbiturates. 

This is now a routine part of prenatal care, and it will detect some malformations and genetic diseases (e.g., nearly aU cases of anencephaly, most cases of open spina bifida, some types of reduced stature conditions, many congenital heart defects). However, the sensitivity of ultrasound diagnosis is low for many conditions (e.g., Down syndrome), and it fails to detect many genetic and biochemical abnormalities. 

Folic acid is a coenzyme involved in the metabolism of one-carbon fragments the methyl, hydroxymethyl, and formyl groups. An inadequate intake of folic acid during pregnancy can result in spina bifida. 

Folic acid (vitamin Bg) is a conjugate of a pteridine unit, p-aminobenzoic acid, and glutamic acid. Deficiency of folic acid leads to anaemia, and it is also standard practice to provide supplementation during pregnancy to reduce the incidence of spina bifida. 

H2. Hellstrom, B., Lindsten, J., et al, Prenatal diagnosis of anencephalus and spina bifida by determination of alphafetoprotein. Lakartidningen 72(4), 236-238 (1975). 

Centers for Disease Control and Prevention (CDC). Spina bifida and anencephaly before and after folic acid mandate-United States, 1995-1996 and 1999-2000. Morb Mort Wkl Rep 2004 53(17) 362-5. 

Folic acid supplements are given to pregnant women to decrease the risk of neural tube defects such as spina bifida. Prenatal vitamin preparations that contain higher concentrations of folic acid must be dispensed under a health care worker s guidance because high folate intakes can mask the symptoms of pernicious anemia. 

B9 19 175 2 10.5 2 1.1 1 Malpositioned kidney 2 Malformed vertebral colmrm, spina bifida... 

Centets fot Disease Control (1995) Surveillance for anencephaly and spina bifida and the importance of prenatal diagnosis. United States, 1985-1994. MMWR CDC Surveill Summ 44 1-13. 

Omtzigt, J.G., Nau, H., Los, F.J., Pijpes, L., and Lindhout, D. (1992) The disposition of valproate and its metabolites in the late first trimester and early second trimester of pregnancy in maternal serum, urine, and amniotic fluid effect of dose, co-medication, and the presence of spina bifida. Eur J Clin Pharmacol 43 381-388. 

Rosa, F.W. (1991) Spina bifida in infants of women treated with carbamazepine during pregnancy. N Egl J Med 324 674—677. 

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