Management of the unanticipated neural tube defect in late pregnancy

The physician who encounters a patient in late pregnancy with a neural tube defect is presented with a difficult task of management and treatment. A thorough examination of the defect(s) is mandatory. This can be accomplished best with ultrasound examination. It is then imperative to assess the severity and survivability of the fetus, and to counsel properly the patient as to diagnosis, severity, and options available. After discussion with the proper consultants, patients should have considerable input into the management, and should be informed adequately to make an intelligent and proper decision. After careful assessment and thorough consultation and counseling with the patient and her support person, therapy can be initiated, followed by some type of grief counseling with appropriate follow-up. Patients also should be informed as to subsequent risks and what, if anything, could possibly be done to prevent recurrences. By this careful and thorough approach it is hoped that physicians who encounter neural tube defects late in pregnancy will make a considerable difference in the physical as well as the emotional health of the patient.