NTD, including open spina bifida, is one of the most important congenital fetal anomalies that have high morbidity and mortality, so early detection during fetal screening is very important to decide on its future. Choosing the right screening method depends on many factors such as financial cost, time cost, accuracy and sensitivity of the measurement method, availability and safety of the measuring tool, and so on. Laboratory evaluation of maternal blood AFP levels is one of the most common and oldest methods of screening for CNS anomalies, which also has a high number of false positives, and therefore the study of alternative methods is important. Therefore, the study and research on ultrasound symptoms of open spina bifida in embryonic screening, including the symptoms of Chiari II, has recently been studied.

In this study, we examined the significance between high maternal blood AFP and OSB incidence, so the percentage of diagnostic accuracy of maternal blood AFP in OSB detection was 7%, which is a very weak value.

In the study of other variables and their relationship with OSB, the variables obliterated IT, decreased CM, decreased BSOB, increased BS, BS/BSOB increased and decreased BPD, ventriculomegaly have a significant sensitivity ‘specifity’ PPV NPV and accuracy.

And we showed that acid folic use had statistically significant relationship with OSB, while this was not the case for maternal age, fetal age, gestational diabetes, and consanguineous marriage.

In a study conducted by Wertaschnigg et al. In Australia in 2019 on the ultrasound signs of OSB in the first trimester, 1003 control samples and 27 cases of OSB on sonographic features were studied and it was concluded that MO and BS/BSOB were the best sonographic markers. For the diagnosis of OSB in the first trimester, the significance of the BS/BSOB variable was similar to our study [17].

In another study, Teegala et al. Conducted an OSB in India in 2017 to examine IT as an ultrasonic marker, during which the first and second trimester sonographic findings were evaluated. In this study, 5 IT cases were detected and in all 5 cases, OSB was discovered and it was concluded that the IT view is a reliable criterion in the first trimester for OSB detection [18]. In our study similar to this study, a significant relationship was found between IT and OSB visibility.

In 2017, a study was conducted in Turkey by Kose on 1479 pregnant women to observe post fossa changes for early diagnosis of OSB in the first trimester. In this study, the landmarks of CM, BSOB, IT and BS were examined and mothers were followed up until the birth of the baby. Two cases of OSB were detected in the infants of these mothers. In these two patients, Landmark CM, BS, BSOB were 100% sensitive and in both patients was impaired and IT was impaired in one of the patients and CM had the highest specificity for OSB (99.9%) of these markers, which were significant results of BSOB, BS, and CM [19]. this is similar to our study.

A 2016 study by Dr. Pascal et al. In the Department of Neuroscience in Italy examined the accuracy of the IT marker in diagnosing OSB in the first trimester. In this study, the results of 9 separate studies were evaluated, which included 21,070 embryos, and IT was evaluated in all of these embryos. In this study, IT sensitivity of 53.5% and specificity of 99.7% were obtained and it was concluded that due to low sensitivity, IT alone is not a good criterion for diagnosing OSB in the first trimester of pregnancy and more studies are needed to discover the sonographic landmark. It is more appropriate to diagnose OSB in the first trimester [20] but in our study a significant relationship was found between IT visibility and OSB.

In a 2017 study by Moradi et al. at Tehran University of Medical Sciences on the distribution and anomalies associated with NTD by prenatal ultrasound in Iranian fetuses. In this study, the highest risk factor was associated with incomplete consumption of folic acid (45%) and then consanguineous marriage. Accompanying anomalies were detected in 66% of fetuses, most of which (90%) were in fetuses with spina bifida. Finally, it was important to conclude that ultrasound is the non-invasive and safe selective modality for detecting prenatal NTD with the utmost accuracy. The accuracy of NTD detection with ultrasound also depends on the type of NTD and the age of the fetus at the time of ultrasound. For example, SB detection is 40% in the first trimester and 92% to 95% in the second trimester. The accuracy of ultrasound to detect OSB in this study was 100% [21]. In our study, the accuracy of ultrasound diagnosis in the detection of fetal OSB was similar to this study was 100%.

A 2019 study by Palomaki et al. On laboratory tests for ONTD at the American Society of Medical Genetics found that increased MS-AFP levels at 16 weeks’ gestation were 80% more sensitive to OSB and 95% more sensitive to diagnosis. Has anencephaly and stated that determining the level of AFP and acetylcholinesterase in the amniotic fluid followed by targeted ultrasound is the diagnostic method of choice in the detection of ONTD [22].

In the American Journal of Pregnancy and Gynecology in 2014, a page was published by Dr. Spencer that evaluated various studies examining the role of serum AFP levels in OSB screening at weeks 11 to 13 and concluded that few studies supported the study of indexes. Laboratories such as AFP and BHCG are available for OSB screening in the first trimester, and these two indexes cannot compete with OSB sonographic criteria such as fruit sign, IT review, and evidence of BPD reduction and are of lower value [23]. In our study, the diagnostic accuracy of AFP was 7%, which is a very low value.

In a study conducted in 2019 by Sirico A et al. On the BS/BSOB criterion in the diagnosis of OSB in the first trimester, 23 positive OSB cases were detected [24]. In our study, this criterion was seen with high sensitivity and specificity.

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