Ultrasound-guided myelomeningocele drainage at time of cesarean section: A case report

Myelomeningocele (MMC) is the most common and complex birth defect of the central nervous system that is compatible with long-term survival. Historically, the preferred mode of delivery has been cesarean; however, more recent literature has questioned the benefit of cesarean delivery or avoidance of labor. A key aspect of this decision is determining the delivery mode which will best protect against rupture of the myelomeningocele, untoward traction on the neural placode, and functional spinal cord rostral to the defect site. Ruptured myelomeningocele is associated with significantly increased morbidity and necessitates urgent surgical repair within the first 72 h of life. There appear to have been no published case reports describing MMC drainage prior to delivery, with the goal of preventing rupture of the MMC. The present report concerns a case of an infant who underwent ultrasound-guided needle decompression of a large MMC prior to delivery. Because of the lack of severe rupture, there was a significant volume of healthy skin available for closure of the defect with no postnatal complications from the procedure. In conclusion, drainage of an MMC may result in a decreased risk of rupture of large MMCs at the time of delivery and may be considered in cases where concern for rupture is particularly high. It is also a procedure that may allow for a reduction in maternal morbidity by reducing the need for highly morbid vertical uterine incisions.