Elevated levels of maternal serum alpha-fetoprotein are usually indicative of spina bifida aperta [180, 181] but can be associated with other conditions (e.g., twin gestation and abnormalities of placentation including placental lakes and placenta previa) and ultrasound is needed to confirm the diagnosis. Screening obstetrical ultrasonography is the initial routine method for the detection of NTDs during pregnancy in many countries. However, it sometimes fails to detect closed spina bifida [182, 183]. In highly specialized fetal centers, use of ultrafast fetal MRI has enabled detailed anatomical evaluation of the defect and accurate assessment of its accompanying effects .