Anencephaly

An anencephalic infant presents a distinctive appearance with a large defect of the calvarium, meninges, and scalp associated with a rudimentary brain, which results from failure of closure of the rostral neuropore, the opening of the anterior neural tube. The primitive brain consists of portions of connective tissue, vessels, and neuroglia. The cerebral hemispheres and cerebellum are usually absent, and only a residue of the brainstem can be identified. The pituitary gland is hypoplastic, and the spinal cord pyramidal tracts are missing owing to the absence of the cerebral cortex. Additional anomalies include folding of the ears, cleft palate, and congenital heart defects in 10–20% of cases. Most anencephalic infants die within several days of birth. The incidence of anencephaly approximates 1/1,000 live births; the greatest frequency is in Ireland, Wales, and Northern China. The recurrence risk is ≈4% and increases to 10% if a couple has had two previously affected pregnancies. Many factors have been implicated as the cause of anencephaly (in addition to a genetic basis), including low socioeconomic status, nutritional and vitamin deficiencies, and a large number of environmental and toxic factors. It is very likely that several noxious stimuli interact on a genetically susceptible host to produce anencephaly. The frequency of anencephaly has been decreasing in the past 2 decades. Approximately 50% of cases of anencephaly have associated polyhydramnios. Couples who have had an anencephalic infant should have successive pregnancies monitored, including amniocentesis, determination of AFP levels, and ultrasound examination between the 14th and 16th wk of gestation