MATERNAL SHUNT DEPENDENCY - IMPLICATIONS FOR OBSTETRIC CARE, NEUROSURGICAL MANAGEMENT, AND PREGNANCY OUTCOMES AND A REVIEW OF SELECTED LITERATURE

OBJECTIVE: Because more women with cerebrospinal fluid shunts are surv iving to child-bearing age, neurosurgeons, obstetricians, and other he alth care professionals require information about the care of these pa tients, especially during pregnancy and delivery. The purpose of this study was to gather comprehensive data from women with shunts regardin g their clinical histories during and immediately after pregnancy. The following questions were addressed. 1) How does maternal shunt depend ency influence the course of pregnancies and pregnancy outcomes? 2) Wh at neurosurgical complications characterize this population of patient s? 3) What complications of shunt dependency influence obstetric manag ement, including prenatal testing and delivery? METHODS: A total of 37 respondents (age, 18-41 yr), accounting for 77 pregnancies, completed a questionnaire providing information on maternal background and medi cal history, shunt performance during pregnancy, management of deliver y, pregnancy outcomes, and unusual complications. RESULTS: Fifty-six p regnancies resulted in live births; of these, 47 occurred in women wit h ventriculoperitoneal shunts. Three women underwent therapeutic abort ions, 1 experienced preterm delivery, and 8 experienced 17 miscarriage s. Four women experienced seizures during pregnancy, five reported thi rd-trimester headaches, and eight described abdominal pains during the first and third trimesters. Four babies were diagnosed as having cong enital defects. Shunt malfunctions and revisions occurred 10 times in 7 women, either during pregnancy or within 6 months after delivery. No acute malfunctions occurred during delivery. Forty-seven cases, repre senting 84% of all pregnancies, exhibited no shunt malfunctions or rev isions. CONCLUSION: This study extends previous observations to a larg er population of shunt-dependent mothers. The results suggest that mat ernal shunt dependency entails a relatively high incidence of complica tions but that proper care of these patients can lead to normal pregna ncies and deliveries.