Nk. Bradley et al., MATERNAL SHUNT DEPENDENCY - IMPLICATIONS FOR OBSTETRIC CARE, NEUROSURGICAL MANAGEMENT, AND PREGNANCY OUTCOMES AND A REVIEW OF SELECTED LITERATURE, Neurosurgery, 43(3), 1998, pp. 448-460
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.