Spinal pathologies in the fetus occur in 1 case per 1000 pregnancies. Often disorders affect not only the spinal column itself, but also the spinal cord. Basically, a fetus with a spinal anomaly dies in utero or immediately after birth, so it is very important to identify the problem as early as possible so that the woman makes a thoughtful decision to terminate the pregnancy.
Causes of intrauterine spinal abnormalities
The content of the article
In most cases, the anomaly occurs in the lumbar region, less often in the cervical region, and very rarely in the sacrum and thoracic region.
The reasons for such a complex pathology are still not clear. But among the factors that provoke disruption of the formation of the spinal cord, we can definitely highlight:
- TORCH infection;
- toxic effects of drugs;
- difficult working conditions;
- drug and alcohol use;
- many years of smoking experience.
Diagnosis of hygroma
To make a diagnosis, as well as to differentiate various types of periarticular pathology, use:
- radiography, which allows you to distinguish hygroma from osteosarcoma, hematoma, lipoma, tuberculosis lesion, osteomyelitis;
- computed tomography, which makes it possible to determine not only the structure of the tumor, but also to identify its exact location and connection with the articular structures;
- puncture biopsy, with the help of which the contents of the cyst are obtained for analysis for the presence of atypical cells - this makes it possible to distinguish a benign process from a malignant one. If pus, caseous masses, or blood are detected in the punctate, the diagnosis of hygroma is considered doubtful.
Myelomeningocele
Myelomeningocele (spina bifida cystica) accounts for 75% of all cases of spinal abnormalities in the fetus. The pathology is expressed in protrusion of the spinal cord beyond the vertebral arch. Sometimes the brain tissue is protected by the skin, but more often it comes out along with the nerve processes. In the latter case, the fetus is born with paralysis of the lower limbs, problems with the intestines and bladder. In 90% of cases, the fetus is diagnosed with hydrocephalus (water on the brain).
Characteristic signs of myelomeningocele on ultrasound:
- fluid is visualized on the back surface of the spine;
- a formation with fluid inside is visible through the vertebral fissure;
- the cranial fossa is smaller;
- cerebellar tissues are displaced;
- pronounced curvature of the spine;
- the size of the fetus is smaller than normal;
- hydrocephalus is diagnosed due to the low position of the spinal cord and blockage of the cerebrospinal fluid.
If a pathology is suspected, a woman donates blood for specific enzymes. Her alpha-fetoprotein levels are elevated, as with other fetal anomalies. Then the pregnant woman is sent for a 4D scan, during which a three-dimensional image of the fetus can be seen. However, this becomes possible only from the 20th week of pregnancy.
Myelomeningocele is a severe form of spina bifida, so if the diagnosis is confirmed by ultrasound, the woman is recommended to have an abortion. Even if the baby is born alive, he will not be able to walk, he will have problems with internal organs.
The operation to move the spinal cord and spinal nerves that have gone beyond the spinal column is carried out within 48 hours from the moment of birth. The protruding capsule is placed back into the spinal canal, and muscle and skin are sutured on top.
Such children require special treatment that will not significantly improve their quality of life. A very low percentage of children will be able to walk in the future, but most will need a wheelchair because the nerve endings become damaged and prevent the spinal cord from functioning properly.
Symptoms of pathology
The first signs of the disease can be observed immediately after birth or in the first few years of life. Most often, cystic hygroma does not manifest itself in any way during the intrauterine development of the fetus. The expectant mother does not experience any discomfort, so pathology is often detected after the birth of the baby. Often, signs of the disease do not appear for the first two years of his life.
As the child grows, the cervical hygroma increases in size, causing pain, and increases during physical activity. Hyperemia begins to develop in the affected area, breathing and swallowing reflex are impaired, and apnea may occur.
A rounded neoplasm up to five centimeters in size appears in the neck area, which can be soft or hard, and cause pain when palpating and moving the head. If there is an inflammatory reaction, redness occurs on the skin. Often, pathology contributes to the appearance of dystrophy due to the inability to eat normally.
The neoplasm can put pressure on blood and lymphatic vessels and disrupt the activity of many body systems. The tumor cannot resolve on its own, so it requires immediate treatment.
Klippel-Feil syndrome
Klippel-Feil syndrome is very rare, occurring in 1 in 120,000 pregnancies, and tends to be inherited.
The pathology consists of an abnormal structure of the cervical spine, in which the vertebrae are fused together. The neck is practically absent and, depending on the type of syndrome, the pathology has other disorders. The most dangerous variety is KFS3, in which not only the cervical vertebrae are fused, but also the thoracic and lumbar vertebrae. Due to non-fusion of the spinal arches, additional ribs are formed.
In addition, the fetus visualizes extra fingers, their underdevelopment or fusion, kidney hypoplasia, fusion of the urethra, diseases of the cardiovascular system, absence of a lung, and disruptions in the functioning of the central nervous system. With any form of the syndrome, the fetus develops a curvature of the spine (scoliosis).
The cause of the pathology is a mutation of the GDF6 gene. The anomaly is detected no earlier than the 20th week of pregnancy. During an ultrasound examination, the following is noticeable on the ultrasound screen:
- shortening of the neck;
- the fetus does not turn its head;
- low hairline at the back of the head;
- facial asymmetry;
- absence of one lung;
- kidney hypoplasia;
- fusion or underdevelopment of the fingers;
- extra number of fingers;
- fusion of vertebrae in various parts of the spine.
The first two types of Klippel-Feil syndrome can be corrected. The child undergoes surgery and then undergoes complex rehabilitation therapy. To date, it will not be possible to completely restore the spine, but a person will be able to live a normal life, because mental abilities are not affected.
In the third form of pathology, the woman will be offered to terminate the pregnancy, because when the vertebrae fuse, the nerve roots are pinched, which causes various diseases of the internal organs to develop. Children with the KFS3 form require special care and still die at an early age.
Treatment methods
If pregnancy continues, treatment of hygroma is carried out in the first days of the newborn’s life. Congenital disorder is treated in two ways - conservative and surgical. If conservative treatment can be carried out from the first days of life, surgical treatment is postponed for several months or even years, depending on the form of hygroma and the severity of associated symptoms.
In general, hygroma itself most often does not pose a danger, since it is a benign neoplasm. The decision to undergo urgent surgery immediately after birth can only be made if the tumor is pressing on important nerve endings or impeding breathing.
Conservative therapy
Ural irradiation warms up well and promotes regeneration processes
Conservative therapy is based on three methods:
- puncture of the tumor followed by sclerosis;
- use of glucocorticosteroids;
- physiotherapeutic methods.
First, a puncture (puncture of the tumor) is performed, with the help of which the accumulated fluid is removed from the cystic neoplasm. The procedure is painless, since before the puncture an anesthetic injection is given into the area of further manipulation. The doctor uses a syringe to make a puncture in the cavity, then uses the same syringe to remove fluid from the cyst.
After the cavity is cleared of liquid contents, a sclerotherapy drug - bleomycin or hemoblock - is injected directly into it. This procedure glues the walls of the vessels from which the tumor is formed, and also promotes further resorption of the hygroma.
After the sclerotherapy procedure, glucocorticosteroids can be used. They are also injected directly into the cavity of the tumor. These medications prevent inflammatory processes, reduce existing swelling and prevent the re-formation of the cyst.
To restore the function of the lymphatic system in the affected area, a course of physiotherapy is prescribed. Electrophoresis of the cervical-collar area is most often recommended. Can be used alone or with medications, for example, hormonal drugs Hydrocortisone. The choice of physiotherapy technique largely depends on the size of the tumor.
The second popular and effective treatment method is ultraviolet irradiation of the affected area. This method stimulates local metabolic processes, eliminates congestion and swelling, and accelerates tissue restoration.
As a rule, a conservative treatment method provides a good therapeutic effect, after which the risk of relapse is minimized. However, after a course of therapy, the child must undergo regular examinations, since no one is immune from the re-formation of hygroma in the same area.
Surgery
The surgical method is inferior in effectiveness to conservative therapy. This is associated with a high risk of complications during surgery, as well as re-formation of hygromas. The fact is that conservative treatment is aimed at restoring the functioning of the lymphatic vessels, as a result of which the re-formation of hygroma is unlikely. Surgical removal of the tumor allows you to quickly and effectively get rid of a cosmetic defect, but does not significantly affect the functioning of the lymphatic system, which is why relapse is possible in the future.
Surgery is most often resorted to in two cases - a visible physical defect caused by a hygroma, and negative consequences associated with breathing problems or compression of nerve endings by a tumor.
The classic method of treatment is removal with a scalpel. The operation is performed under general anesthesia. The doctor removes the tumor along with the tissue that forms the cyst capsule, then applies sutures. The disadvantages of the operation are that a scar remains and the wound may become infected.
The second method, more gentle and effective, is laser burning of the hygroma. The hygroma is destroyed from the inside, as laser radiation causes the liquid in the tumor tissue to boil. The advantages of the method are fast rehabilitation, absence of scars. With laser removal there is a minimal risk of bleeding and relapse.
Spina bifida
Spina bifida or incomplete closure of the spinal canal, which occurs in early pregnancy due to improper formation of the nerve root. In addition to problems with the spine, with Spina bifida there is underdevelopment of the spinal cord. 95% of children with this pathology are born to completely healthy young parents.
The mildest form of pathology is Spina bifida occulta - a small gap in the spinal column, not accompanied by protrusion of the spinal cord and damage to the nerve roots. The defect is practically invisible from the outside, and from the outside it is difficult to say that there is some kind of problem.
Sometimes a newborn has problems with the intestines and bladder, scoliosis and weak leg tone. The only way to diagnose pathology is radiography. It is practically invisible on a screening ultrasound; only with a 4D ultrasound can one see incomplete fusion of the spinal arches in late pregnancy. The anomaly does not require correction, and the woman does not need to terminate her pregnancy.
How often should you have an ultrasound during pregnancy?
The standard number of procedures is 2-3, but in some cases the patient has to visit the diagnostic room several times a month. These are women who are at risk due to the high likelihood of developing abnormalities in the fetus. People in this category include:
- over 35 years old;
- having children with congenital pathologies;
- with a family history;
- exposed to radiation, in contact with toxic substances;
- having a history of premature birth, cases of stillbirth or fetal death in the womb, miscarriages.
Do not be alarmed if the doctor prescribes an additional ultrasound - careful monitoring of the condition of the fetus allows you to avoid congenital pathologies and notice deviations from the norm in the early stages.
Cystic hygroma of the neck
Hygroma on the fetal neck (lymphangioma) is a benign tumor that is formed as a result of disruption of the formation of the lymph system in the area of the cervical vertebrae during embryonic development. If the lymph flow is disrupted at the junction of the jugular sac with the jugular vein, a cyst or several cysts filled with fibroserous fluid are formed. The tumor is localized near the cervical vertebrae, affecting the development of the fetus.
Pathology on ultrasound can be seen already at the 1st screening for a period of 11-12 weeks. The main indicator will be an increase in the thickness of the collar space. Neck hygroma in the fetus occurs both as a result of chromosomal abnormalities and under the influence of external causes - mechanical intrauterine trauma, smoking and alcohol consumption by the mother, infections suffered during pregnancy.
At the 2nd screening, the hygroma is visualized as an asymmetric neoplasm with a dense shell, sometimes with septa inside, located in the projection of the cervical spine. The tumor itself does not pose a threat to the life of the fetus.
In the early stages, a chorionic villus biopsy is performed to identify chromosomal abnormalities. If they are confirmed, the woman will be offered to terminate the pregnancy. In the absence of genetic abnormalities, doctors take a wait-and-see approach. very often, by 18-20 weeks of pregnancy, the hygroma resolves on its own.
If this does not happen, then after birth the baby is likely to have the following abnormalities:
- paresis of the facial nerve - immobilization of the facial muscles due to prolonged compression of the nerve fiber by the hygroma;
- spinal deformity (the most common is torticollis - curvature of the cervical spine due to an inflammatory process in the neck muscles due to overexertion of the constant pressure of the tumor);
- deformation of the occipital bone and jaw;
- swallowing dysfunction;
- obstruction of the respiratory tract (obstruction of the respiratory canal due to blockage of the trachea by hygroma).
Hygroma is treated conservatively after the birth of the child. If the cause of the pathology is not chromosomal abnormalities, the prognosis for the baby is favorable.
Prevention
Various reasons lead to the development of fetal neck hygroma, and a woman can influence some of them. Of course, no one is immune from chromosomal abnormalities, and even geneticists often cannot predict their occurrence, but you can protect yourself from injuries and infections during pregnancy. To do this, you need to approach the issue of conception wisely and plan for a new addition to the family, and not rely on chance. Strong immunity, timely vaccinations against infectious diseases and careful attention to one’s own health are what can prevent the development of hygroma in the fetus.
In addition, when planning a pregnancy and subsequent bearing a child, a woman should eat properly and not drink alcohol or drugs. Smoking and other bad habits and addictions should be stopped at least six months before the expected conception.
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Postoperative period
If there is no inflammation in the postoperative wound, the sutures are removed after 5-7 days. If the wound becomes infected, they may be removed earlier to re-debride the wound with antiseptics. In this case, recovery may take a longer period of time.
After removal of a hygroma of the wrist joint, a patient whose work involves constant trauma to this area is recommended to change profession. This is the only way to reduce the likelihood of relapse to a minimum. Foot hygroma in children is most often caused by flat feet, so timely correction is required. This will avoid not only the recurrence of this pathology, but also the development of other problems in adulthood.
Special situations
Sometimes the patient can crush the hygroma. Previously, they tried to treat her in exactly this way and operated on only in case of a subsequent relapse, which occurred very often.
The consequences of a burst hygroma on a finger are usually negligible, since its contents are sterile. However, the patient should observe the area where it was located. If signs of inflammation or rapid subsequent growth appear, the specialists of our dobrobut.com clinic recommend immediately consulting a doctor.
Hygroma is mostly a cosmetic defect, although sometimes it can cause a lot of inconvenience. In any case, it must be treated with the help of specialists.
Related services: Orthopedics and traumatology Arthroscopy