Pregnancy care and perinatal outcomes in pregnant women with a shunt for hydrocephalus

Czech version

Authors: V. Vybíhal ¹; Lukáš Hruban ²; Martin Plevko ¹; Veronika Ťápalová ²; Anna Jouzová ²; Miloš Keřkovský ³; Marek Sova ¹; Pavel Fadrus ¹; Martin Smrčka ¹
Authors‘ workplace: Neurochirurgická klinika LF MU a FN Brno ¹; Gynekologicko-porodnická klinika LF MU a FN Brno ²; Klinika radiologie a nukelární medicíny LF MU a FN Brno ³
Published in: Ceska Gynekol 2024; 89(5): 417-423
Category:
doi: https://doi.org/10.48095/cccg2024417

Overview

The number of patients with an implanted shunt reaching reproductive age and planning pregnancy is increasing thanks to advances in the treatment of hydrocephalus. Changes in the mother‘s organism, which are mainly related to the accumulation of water in the organism and the elevation of intra-abdominal pressure, contribute to the increased incidence of complications during pregnancy and childbirth. Therefore, it is necessary to make a preconception exam and specify pregnancy management, a suitable method of childbirth dealing with potential complications. Possible malfunction of the shunt is solved individually according to the current neurological findings and taking into account the patient‘s overall condition and gestational age. Vaginal delivery is considered safe and preferred by most authors. Primary caesarean section is indicated only in patients with a history of rapidly progressing deterioration of the neurological condition due to shunt malfunction or serious complications related to its impaired shunt function. In an uncomplicated pregnancy with normal values of intracranial pressure, both general and epidural or spinal anesthesia can be used when choosing anesthesia.

Keywords:

hydrocephalus – pregnancy – shunt – ventriculoperitoneal shunt – ventriculoatrial shunt – lumboperitoneal shunt

Sources

1. Yu JN. Pregnancy and extracranial shunts: case report and review of the literature. J Fam Pract 1994; 38 (6): 622–626.

2. Krauss P, Fritz-Naville M, Regli L et al. Progressive functional underdrainage in cerebrospinal fluid shunt-dependent women during pregnancy: case report and review of the literature. World Neurosurg 2018; 109: 372–376. doi: 10.1016/j.wneu.2017.09.108.

3. Dandy WE. Extirpation of the choroid plexus of the lateral ventricles in communicating hydrocephalus. Ann Surg 1918; 68 (6): 569–579. doi: 10.1097/00000658-191812000-00001.

4. Isaacs AM, Riva-Cambrin J, Yavin D et al. Age-specific global epidemiology of hydrocephalus: systematic review, metanalysis and global birth surveillance. PLoS One 2018; 13 (10): e0204926. doi: 10.1371/journal.pone.0204926.

5. Wu Y, Green NL, Wrensch MR et al. Ventriculoperitoneal shunt complications in California: 1990 to 2000. Neurosurgery 2007; 61 (3): 557–563. doi: 10.1227/01.NEU.0000290903.07943.AF.

6. Williams MA, Nagel SJ, Luciano MG et al. The clinical spectrum of hydrocephalus in adults: report of the first 517 patients of the Adult Hydrocephalus Clinical Research Network registry. J Neurosurg 2020; 132 (6): 1773–1784. doi: 10.3171/2019.2.JNS183538.

7. Kala M. Hydrocefalus. Praha: Galén 2005.

8. Monfared AH, Koh KS, Apuzzo ML et al. Obstetric management of pregnant women with extracranial shunts. Can Med Assoc J 1979; 120 (5): 562–563.

9. Bradley NK, Liakos AM, McAllister JP 2nd et al. Maternal shunt dependency: implications for obstetric care, neurosurgical management, and pregnancy outcomes and a review of selected literature. Neurosurgery 1998; 43 (3): 448–461. doi: 10.1097/00006123-199809000-00030.

10. Liakos AM, Bradley NK, Magram G et al. Hydrocephalus and the reproductive health of women: the medical implications of maternal shunt dependency in 70 women and 138 pregnancies. Neurol Res 2000; 22 (1): 69–88. doi: 10.1080/01616412.2000.11741040.

11. Wisoff JH, Kratzert KJ, Handwerker SM et al. Pregnancy in patients with cerebrospinal fluid shunts: report of a series and review of the literature. Neurosurgery 1991; 29 (6): 827–831.

12. Wang X, Wang H, Fan Y et al. Management of acute hydrocephalus due to pregnancy with ventriculoperitoneal shunt. Arch Gynecol Obstet 2013; 288 (5): 1179–1182. doi: 10.1007/s00404-013-2858-0.

13. Zabramski JM, Preul MC, Debbins J et al. 3T magnetic resonance imaging testing of externally programmable shunt valves. Surg Neurol Int 2012; 3: 81. doi: 10.4103/2152-7806.99171.

14. Murakami M, Morine M, Iwasa T et al. Management of maternal hydrocephalus requires replacement of ventriculoperitoneal shunt with ventriculoatrial shunt: a case report. Arch Gynecol Obstet 2010; 282 (3): 339–342. doi: 10.1007/s00404-010-1379-3.

15. Oatridge A, Holdcroft A, Saeed N et al. Change in brain size during and after pregnancy: study in healthy women and women with preeclampsia. AJNR Am J Neuroradiol 2002; 23 (1): 19–26.

16. Riffaud L, Ferre JC, Carsin-Nico B et al. Endoscopic third ventriculostomy for the treatment of obstructive hydrocephalus during pregnancy. Obstet Gynecol 2006; 108 (3 Pt 2): 801–804. doi: 10.1097/01.AOG.0000214676.168 25.85.

17. Littleford JA, Brockhurst NJ, Bernstein EP et al. Obstetrical anesthesia for a parturient with a ventriculoperitoneal shunt and third ventriculostomy. Can J Anaesth 1999; 46 (11): 1057–1063. doi: 10.1007/BF03013202.

18. Cusimano MD, Meffe FM, Gentili F et al. Management of pregnant women with cerebrospinal fluid shunts. Pediatr Neurosurg 1991; 17 (1): 10–13. doi: 10.1159/000120558.

19. Karanth S, Sheela CN, Chhabra M. Malfunction of ventriculoperitoneal shunt during pregnancy: A case report. Int J Pharm Biomed Res 2011; 2 (4): 266–268.

20. Sova M, Smrčka M, Baudyšová O et al. Management of a shunt malfunction during pregnancy. Bratisl Lek Listy 2001; 102: 562–563.

21. Okagaki A, Kanzaki H, Moritake K et al. Case report: pregnant woman with ventriculoperitoneal shunt to treat hydrocephalus. Asia Oceania J Obstet Gynaecol 1990; 16 (2): 111–113. doi: 10.1111/j.1447-0756.1990.tb00011.x.

22. Fletcher H, Crandon IW, Webster D. Maternal hydrocephalus in pregnancy and delivery: a report of two cases. West Indian Med J 2007; 56 (6): 558–559.

23. Surov A, Koman G, Behrmann C et al. A rare cause of ventriculoatrial shunt malfunction. Clin Neurol Neurosurg 2009; 111 (3): 310–311. doi: 10.1016/j.clineuro.2008.10.011.

24. Hwang SC, Kim TH, Kim BT et al. Acute shunt malfunction after cesarean section delivery: a case report. J Korean Med Sci 2010; 25 (4): 647–650. doi: 10.3346/jkms.2010.25.4.647.

25. Nikolov A, Surchev ZH, Nalbanski B et al. Pregnancy and delivery in women with cerebrospinal fluid shunt due to hydrocephalus. Akush Ginekol (Sofiia) 2008; 47 (2): 3–10.

26. Leffert LR, Schwamm LH. Neuraxial anesthesia in parturients with intracranial pathology: a comprehensive review and reassessment of risk. Anesthesiology 2013; 119 (3): 703–718. doi: 10.1097/ALN.0b013e31829374c2.

27. Abouleish E, Ali V, Tang RA. Benign intracranial hypertension and anesthesia for cesarean section. Anesthesiology 1985; 63 (6): 705–707. doi: 10.1097/00000542-198512000-00029.

28. Rajagopalan S, Gopinath S, Trinh VT et al. Anesthetic considerations for labor and delivery in women with cerebrospinal fluid shunts. Int J Obstet Anesth 2017; 30: 23–29. doi: 10.1016/j.ijoa.2017.01.005.

ORCID autorů

V. Vybíhal 0000-0002-5154-5591

L. Hruban 0000-0001-8594-2678

M. Plevko 0000-0002-9174-7788

V. Ťápalová 0009-0008-6574-0321

A. Jouzová 0000-0002-1229-4283

M. Keřkovský 0000-0003-0587-9897

M. Sova 0000-0001-7382-9811

P. Fadrus 0000-0003-3259-1100

M. Smrčka 0000-0002-9191-8700

Doručeno/Submitted: 13. 3. 2024

Přijato/Accepted: 14. 3. 2024