Endorsed but Undefined: Multidisciplinary Counselling for Closed Spinal Dysraphism - A National Multispecialty Survey from India.

Objective To characterize current antenatal management practices for closed spinal dysraphism (CSD) among Indian specialists and determine whether practice variation is specialty-dependent or distributed within specialties. Methods A cross-sectional expert-reviewed and pilot-tested web-based survey (15 substantive items) was distributed to obstetricians, perinatologists, and radiologists across India (January-September 2023). Descriptive statistics and chi-square tests were used to evaluate the associations between respondents' characteristics and clinical practices. Response dispersion was quantified using normalized Shannon entropy (nH). Results Of the 209 respondents (104 obstetricians, 54 perinatologists, 51 radiologists), 89.5% encountered <10 CSD cases annually. Only 60.5% of the participants attempted to subtype CSD. Fetal MRI was available to 63.6% of respondents, with significantly higher access at tertiary centers (p < 0.001). While 83.3% endorsed mandatory multidisciplinary counseling, attitudes toward medical termination of pregnancy were widely divergent (normalized Shannon entropy: 0.931). No statistically significant interspecialty differences were found for the clinical decision-making domains, including subtyping, prognostication, MRI, and MTP attitudes (all p > 0.34), indicating that variation in counselling content resided within, rather than between, specialties. Conclusion Antenatal CSD management in India shows wide practice variation that is distributed uniformly within, rather than between, specialties. This pattern is consistent with an absence of condition-specific evidence and guidance rather than with specialty-specific disagreement, and supports the development of standardized prenatal reporting, defined MRI indications, and collaborative evidence-based guidelines.