{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T14:45:43Z","timestamp":1781707543186,"version":"3.54.5"},"reference-count":14,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2020,6,1]],"date-time":"2020-06-01T00:00:00Z","timestamp":1590969600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp; Gyne"],"published-print":{"date-parts":[[2020,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To determine whether the presence of a myelomeningocele (MMC) sac and sac size correlate with compromised lower\u2010extremity function in fetuses with open spinal dysraphism.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A radiology database search was performed to identify cases of MMC and myeloschisis (MS) diagnosed prenatally in a single center from 2013 to 2017. All cases were evaluated between 18 and 25 weeks. Ultrasound reports were reviewed for talipes and impaired lower\u2010extremity motion. In MMC cases, sac volume was calculated from ultrasound measurements. Magnetic resonance imaging reports were reviewed for hindbrain herniation. The association of presence of a MMC sac and sac size with talipes and impaired lower\u2010extremity motion was assessed. <jats:italic>Post\u2010hoc<\/jats:italic> analysis of data from the multicenter Management of Myelomeningocele Study (MOMS) randomized controlled trial was performed to confirm the study findings.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In total, 283 MMC and 121 MS cases were identified. MMC was associated with a lower incidence of hindbrain herniation than was MS (80.9% <jats:italic>vs<\/jats:italic> 100%; <jats:italic>P<\/jats:italic> &lt; 0.001). Compared with MS cases, MMC cases with hindbrain herniation had a higher rate of talipes (28.4% <jats:italic>vs<\/jats:italic> 16.5%, <jats:italic>P<\/jats:italic> = 0.02) and of talipes or lower\u2010extremity impairment (34.9% <jats:italic>vs<\/jats:italic> 19.0%, P = 0.002). Although there was a higher rate of impaired lower\u2010extremity motion alone in MMC cases with hindbrain herniation than in MS cases, the difference was not statistically significant (6.6% <jats:italic>vs<\/jats:italic> 2.5%; <jats:italic>P<\/jats:italic> = 0.13). Among MMC cases with hindbrain herniation, mean sac volume was higher in those associated with talipes compared with those without talipes (4.7 \u00b1 4.2 <jats:italic>vs<\/jats:italic> 3.0 \u00b1 2.6 mL; <jats:italic>P<\/jats:italic> = 0.002). Review of the MOMS data demonstrated similar findings; cases with a sac on baseline imaging had a higher incidence of talipes than did those without a sac (28.2% <jats:italic>vs<\/jats:italic> 7.5%; <jats:italic>P<\/jats:italic> = 0.007).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In fetuses with open spinal dysraphism, the presence of a MMC sac was associated with fetal talipes, and this effect was correlated with sac size. The presence of a larger sac in fetuses with open spinal dysraphism may result in additional injury through mechanical stretching of the nerves, suggesting another acquired mechanism of injury to the exposed spinal tissue. Copyright \u00a9 2019 ISUOG. Published by John Wiley &amp; Sons Ltd.<\/jats:p><\/jats:sec>","DOI":"10.1002\/uog.21891","type":"journal-article","created":{"date-parts":[[2019,10,15]],"date-time":"2019-10-15T12:51:43Z","timestamp":1571143903000},"page":"740-746","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":29,"title":["Myelomeningocele sac associated with worse lower\u2010extremity neurological sequelae: evidence for prenatal neural stretch injury?"],"prefix":"10.1002","volume":"55","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5821-5085","authenticated-orcid":false,"given":"E. R.","family":"Oliver","sequence":"first","affiliation":[{"name":"Perelman School of Medicine University of Pennsylvania  PA USA"},{"name":"Center for Fetal Diagnosis and Treatment Children's Hospital of Philadelphia  PA USA"},{"name":"Department of Radiology Children's Hospital of Philadelphia  Philadelphia PA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G. G.","family":"Heuer","sequence":"additional","affiliation":[{"name":"Perelman School of Medicine University of Pennsylvania  PA USA"},{"name":"Center for Fetal Diagnosis and Treatment Children's Hospital of Philadelphia  PA USA"},{"name":"Department of Surgery Children's Hospital of Philadelphia  Philadelphia PA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E. A.","family":"Thom","sequence":"additional","affiliation":[{"name":"The George Washington University Biostatistics Center  Washington DC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P. K.","family":"Burrows","sequence":"additional","affiliation":[{"name":"The George Washington University Biostatistics Center  Washington DC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R. A.","family":"Didier","sequence":"additional","affiliation":[{"name":"Perelman School of Medicine University of Pennsylvania  PA USA"},{"name":"Center for Fetal Diagnosis and Treatment Children's Hospital of Philadelphia  PA USA"},{"name":"Department of Radiology Children's Hospital of Philadelphia  Philadelphia PA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S. E.","family":"DeBari","sequence":"additional","affiliation":[{"name":"Center for Fetal Diagnosis and Treatment Children's Hospital of Philadelphia  PA USA"},{"name":"Department of Radiology Children's Hospital of Philadelphia  Philadelphia PA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. S.","family":"Martin\u2010Saavedra","sequence":"additional","affiliation":[{"name":"Center for Fetal Diagnosis and Treatment Children's Hospital of Philadelphia  PA USA"},{"name":"Department of Radiology Children's Hospital of Philadelphia  Philadelphia PA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. S.","family":"Moldenhauer","sequence":"additional","affiliation":[{"name":"Perelman School of Medicine University of Pennsylvania  PA USA"},{"name":"Center for Fetal Diagnosis and Treatment Children's Hospital of Philadelphia  PA USA"},{"name":"Department of Surgery Children's Hospital of Philadelphia  Philadelphia PA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J.","family":"Jatres","sequence":"additional","affiliation":[{"name":"Center for Fetal Diagnosis and Treatment Children's Hospital of Philadelphia  PA USA"},{"name":"Department of Surgery Children's Hospital of Philadelphia  Philadelphia PA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L. J.","family":"Howell","sequence":"additional","affiliation":[{"name":"Center for Fetal Diagnosis and Treatment Children's Hospital of Philadelphia  PA USA"},{"name":"Department of Surgery Children's Hospital of Philadelphia  Philadelphia PA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N. S.","family":"Adzick","sequence":"additional","affiliation":[{"name":"Perelman School of Medicine University of Pennsylvania  PA USA"},{"name":"Center for Fetal Diagnosis and Treatment Children's Hospital of Philadelphia  PA USA"},{"name":"Department of Surgery Children's Hospital of Philadelphia  Philadelphia PA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B. G.","family":"Coleman","sequence":"additional","affiliation":[{"name":"Perelman School of Medicine University of Pennsylvania  PA USA"},{"name":"Center for Fetal Diagnosis and Treatment Children's Hospital of Philadelphia  PA USA"},{"name":"Department of Radiology Children's Hospital of Philadelphia  Philadelphia PA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,6]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s002340000325"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(98)00070-1"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1053\/jpsu.2003.50078"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrdp.2015.7"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1159\/000364806"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00247-010-1583-0"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1159\/000363738"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00247-010-1708-5"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2017.12.001"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1159\/000103294"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1014379"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.2214\/AJR.18.20088"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1227\/00006123-199006000-00011"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00330-017-4807-y"}],"container-title":["Ultrasound in Obstetrics &amp; Gynecology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fuog.21891","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/uog.21891","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/uog.21891","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/uog.21891","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,5]],"date-time":"2023-09-05T23:51:07Z","timestamp":1693957867000},"score":1,"resource":{"primary":{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/10.1002\/uog.21891"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,6]]},"references-count":14,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2020,6]]}},"alternative-id":["10.1002\/uog.21891"],"URL":"https:\/\/doi.org\/10.1002\/uog.21891","archive":["Portico"],"relation":{},"ISSN":["0960-7692","1469-0705"],"issn-type":[{"value":"0960-7692","type":"print"},{"value":"1469-0705","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,6]]},"assertion":[{"value":"2019-05-26","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-09-27","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-06-01","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}