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Myelomeningocele (MMC) is a congenital birth defect of the spine and spinal cord. A serious form of spina bifida, myelomeningocele occurs when a baby’s spine (the backbone), spinal cord and spinal canal don’t close as they normally would.
This condition develops before birth, usually within the third or fourth week of pregnancy.
Spina bifida occurs in the first three to four weeks of a woman’s pregnancy when the spinal cord is forming. At this point, a baby’s developing brain and spine are referred to as the “neural tube.”
Normally, during these first few weeks of development, the two sides of a baby's back (known as the neural plate and surrounding tissues) fold to form a tube called the spinal cord. The spinal cord separates from the covering tissues, including the meninges, bone and muscles.
MMC is a neural tube defect in which the bones of the spine don’t completely form, resulting in an incomplete spinal canal. Because the spinal canal remains open, the spinal cord and meninges protrude from the baby’s back.
Babies with MMC-type spina bifida can have a sac protruding from the opening in the spine. This sac may contain:
Spina bifida is caused by incomplete closure and development of the fetal spine very early in pregnancy. The exact cause of MMC is not completely understood, but evidence suggests that genes and environmental factors may be involved.
From an unexpected diagnosis to an amazing outcome, this is the story of a little boy who made his family “perfect.”
Read this family’s journey and see how the Colorado Fetal Care Center was there through diagnosis, treatment and beyond – giving them hope for their son.
For baby Peyton, expert spina bifida care before and after birth made all the difference. Read her story to see how prenatal spina bifida surgery and our doctor’s expertise treated her myeloschisis and side-stepped a hydrocephalus scare.
MMC is one of the most common birth defects, but its complications – including abnormal spinal cord and nerve function – can range from mild to severe.
The symptoms and complications of MMC include:
No, a pregnant mother won’t experience any symptoms indicating her baby has MMC.
The signs and indicators that a fetus may have myelomeningocele usually present during the tests and screenings that many pregnant mothers undergo.
Your doctor may suspect, identify and diagnose your baby with MMC based off the findings of various prenatal and fetal diagnostic tests, including:
A maternal fetal medicine specialist will diagnose a fetus with MMC using an ultrasound.
Your neonatologist or neurosurgeon may also diagnose MMC after your baby is born using imaging of their spine, such as:
While an MMC diagnosis may be life-changing, there are myelomeningocele treatment options available that may help your child thrive – both during pregnancy and after they’ve entered the world.
And at the Colorado Fetal Care Center, your treatment options are more than just that – they’re carefully designed strategies to give your baby the best quality of life. We have a specialized team dedicated to treating babies with myelomeningocele. And as one of the nation’s top fetal care centers, we offer some of the most innovative fetal therapies available.
Before determining if a patient qualifies for MMC fetal surgery, our fetal care team works closely with you and collaborates with other specialists. Before deciding on a course of action, we evaluate your baby’s particular condition and the severity of their MMC using fetal diagnostic tests like ultrasound, MRI and echocardiography. Only then do we design and offer a treatment plan.
For some families, our fetal experts offer to treat MMC before the baby is even born by performing a myelomeningocele repair in utero. We choose to perform this open fetal surgery if it can:
When a fetus has an open neural tube defect like MMC, their nerves are exposed to elements that could cause further harm, like amniotic fluid, cerebrospinal fluid and direct trauma.
During the MMC fetal surgery, a maternal fetal medicine specialist will make an incision in the abdomen to open the uterus and expose the defect in your baby's spine. Then a highly specialized pediatric neurosurgeon will repair the myelomeningocele and close the skin of your baby’s back over the opening to protect their still-developing neural tissue – all while you’re still pregnant.
Before the procedure begins, your obstetric and fetal anesthesiologist will administer anesthesia to put you to sleep and relax the uterus; the anesthesia passes through the placenta to your unborn child, allowing the surgical team to open the uterus, perform the in-utero MMC repair and close the uterus – all without interfering with your pregnancy.
Once the procedure is finished, we leave the baby to keep growing and developing, all while monitoring closely with frequent ultrasounds. We’ll then deliver your baby via cesarean section around 37 weeks’ gestation.
Risks to the mother from open fetal surgery may include obstetrical complications and potential scarring that could affect future pregnancies.
There is some risk to the fetus during in-utero surgery, but the team at the Colorado Fetal Care Center has successfully performed over 50 prenatal spina bifida repairs. In our dedicated fetal surgery suite, our team of specialists is ready and capable of handling anything that may occur during the treatment or birth process.
If your fetal care team decides the best course of action is to repair your baby’s MMC after they’re born, the treatment includes:
Your child’s care team will also evaluate them for signs of increased pressure in their brain (a condition known as hydrocephalus). If present, they’ll likely insert a ventriculoperitoneal shunt, which is a tube that helps to drain excess spinal fluid from the brain into the abdominal cavity.
And care doesn’t stop once your child is born. They’ll receive follow-up care and be monitored by a multidisciplinary team of neurology, orthopedic, occupational therapy, pediatric, physical therapy and urology specialists, and others as needed.
Our team at the Colorado Fetal Care Center has the experience and expertise to meet any of your and your baby’s needs. From pregnancy management and diagnosis, to treatment and long-term pediatric subspecialty care, we have the capabilities, team and facilities to provide the highest quality care and best possible outcome.
Our average delivery age for babies who’ve undergone in-utero MMC repair is 34 weeks, meaning we give your baby as much time as possible to grow.
When you come to the Colorado Fetal Care Center for the diagnosis and treatment of your baby’s myelomeningocele, you’re cared for by a dedicated team of experts who have spent years researching, innovating and performing this treatment.
Comprehensive, consistent care
We make it easier on mom, baby and the whole family by surrounding you with the same faces every day. You’ll meet with every provider on your care team on day one. And this same team will be with you every step of the way, so they know all the details of your case. And we know that your baby’s needs won’t end at delivery, which is why we make the transition to the NICU, specialty care and home as seamless as possible.
No question goes unanswered
All of these specialists and providers are under the same roof at Children’s Hospital Colorado. This means that your questions are answered faster, you have instant access to our expertise, and we’re ready to handle anything that may arise.
We keep families together
We know how nervous and excited you are to meet your new baby, which is why we keep your family close together. In fact, Children’s Colorado is one of the few children's hospitals in the nation with a labor and delivery unit.
Our Maternal Fetal Care Unit (MFCU) and Level IV Neonatal Intensive Care Unit (NICU) are right down the hall from each other, so you’re able to easily visit your newborn as much as possible, and this is all under the same roof as nationally-ranked pediatric care.
If you are interested in learning more about our fetal care specialists, please contact the Colorado Fetal Care Center at 1-855-413-3825.
Spina bifida is a lifelong disability and the symptoms, complications and long-term outlook for MMC spina bifida patients are different for every person.
The severity of MMC complications depends on:
MMC can develop anywhere along the spinal cord, but it happens most commonly in a baby’s lower back – known as the lumbar and sacral regions. Nerve damage occurs below the point of the spine where the myelomeningocele has developed.
Therefore, babies with MMC lower in the spine tend to have less severe symptoms, while those with MMC higher in the spine tend to experience more severe symptoms because the nerve damage affects more of the spine.
The milder version of MMC occurs when the vertebral openings are too small for the spinal cord to protrude through. In the more severe category, a portion of the spinal cord protrudes through the vertebral opening.
Babies born with these mild forms of spina bifida and MMC are unlikely to suffer long-term health problems and can lead normal lives, while a baby with severe MMC requires dedicated medical attention.
Spina bifida can be closed or open. If the nerves are covered with skin or fatty tissue, the defect is closed. If the nerves are not covered by anything, the defect is open.
Open defects tend to be more severe, because the nerves are damaged by amniotic fluid and contact with the uterine environment and wall.
There are four different types of spina bifida:
No, MMC and the other forms of spina bifida are congenital birth defects, meaning a baby is born with this defect. However, sometimes the milder forms of spina bifida occulta aren’t diagnosed until after the baby is born.
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