With the use of food fortification with folic acid, the incidence of myelomeningocele in the USA is 3.4 per 10 000 live-births. Ultrasound imaging in utero suggests that the neurological deficit from myelomeningocele is progressive during pregnancy. Prenatal repair of myelomeningocele was first done in 1997 and evidence suggests that it may improve neurological outcomes but with increased fetal and maternal risks. Now (N Scott Adzick and colleagues. N Engl J Med 2011;364:993–1004; see also editorial, ibid: 1076–7) a randomised …