Neural tube defects arise from a failure of the embryonic neural tube to close completely during the first month of pregnancy, usually between the 21st and 28th days after conception. During normal development, the neural plate folds inward to form the neural tube, closing first in the cervical region and zippering outward toward the cranial and caudal neuropores. When the cranial neuropore fails to close, anencephaly results. When the caudal neuropore remains open, various forms of spina bifida occur. Because many Nigerian women present for their first antenatal visit well after the first trimester, this critical window of embryological development has already passed, making primary prevention before pregnancy vital.
Neural tube defects present in several distinct anatomical forms, ranging from mild closed spinal defects to fatal brain malformations.
Detecting neural tube defects before birth allows parents and healthcare teams to prepare for specialized delivery and immediate neonatal management. Diagnostic tools include:
When a baby is born with a neural tube defect, a prompt, gentle physical examination determines the exact location, size, and integrity of the lesion. For infants with open spina bifida or myelomeningocele, the midwife must inspect the back to see if the meningeal sac is intact or ruptured, as a leaking sac invites central nervous system infection. Tone in the lower limbs, spontaneous movement, and reflex responses are evaluated to map out neurological function. The midwife also checks for associated anomalies such as hydrocephalus by measuring head circumference and assessing the anterior fontanelle for fullness or bulging.
Preventing infection and protecting exposed neural tissue are the cornerstones of immediate nursing and midwifery care in the delivery room. The infant should be nursed in a prone or lateral position to prevent pressure and trauma to the back lesion. The exposed sac must be covered immediately with a sterile, warm, saline-soaked gauze dressing, wrapped loosely to avoid drying out or tearing. Midwives must strictly avoid using adhesive tapes directly near the lesion and ensure diapers are kept well away from the area to prevent fecal contamination.
Surgical closure of open neural tube defects is typically performed within the first 24 to 48 hours of life to minimize the risk of infection and preserve existing neurological function. A pediatric surgeon or neurosurgeon carefully dissects the meninges, repositions neural elements back into the spinal canal when possible, and closes the muscular and skin layers over the defect. Post-surgery, the baby requires long-term, coordinated care involving pediatricians, neurosurgeons, physiotherapists, and orthopedic specialists to manage motor deficits, bladder training, and potential shunt insertions for hydrocephalus.
Primary prevention is the most effective weapon against neural tube defects. Daily periconceptional folic acid supplementation—starting at least one month before conception and continuing through the first trimester—dramatically reduces the incidence of these anomalies. Midwives play an essential role in community health education by advising women of childbearing age, especially those with a history of affected pregnancies or those taking anti-seizure medications, to take high-dose folic acid supplements. Promoting dietary diversification with green leafy vegetables, beans, and fortified foods further supports maternal and fetal health across Nigerian communities.