Pregnancy and delivery in patients with an implanted shunt for hydrocephalus

Czech version

Authors: V. Vybíhal ¹; R. Gerychová ²; P. Janků ²; G. Hanoun ¹; M. Sova ¹; P. Fadrus ¹; M. Smrčka ¹; M. Keřkovský ³
Authors‘ workplace: Neurochirurgická klinika, LF MU a FN, Brno, přednosta prof. MUDr. M. Smrčka, Ph. D., MBA ¹; Gynekologicko-porodnická klinika, LF MU a FN, Brno, přednosta prof. MUDr. P. Ventruba, DrSc. ²; Radiologická klinika, LF MU a FN, Brno, přednosta prof. MUDr. V. Válek, CSc., MBA ³
Published in: Ceska Gynekol 2014; 79(4): 309-313

Overview

Hydrocephalus is a disorder of abnormal accumulation of cerebrospinal fluid in the intracranial space, usually in the cerebral ventricles. The number of patients reaching reproductive age and intending to become pregnant has increased in recent years because of treatment advances. An implanted shunt is usually introduced into the abdominal cavity (ventriculoperitoneal shunt). Numerous changes occur during pregnancy, mainly increased accumulation of water, increased intracranial cerebrospinal fluid volume and increased intra-abdominal pressure as a result of the growing uterus. These changes contribute to 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 and dealing with potential complications. Multidisciplinary care is mandatory with the dominant cooperation of obstetricians and neurosurgeons who should be also available during the delivery when needed. Possible shunt malfunction is necessary to diagnose properly and in time and solve it individually, taking into account the overall and neurological status of the patient and gestational age. The presence of a shunt does not affect pregnancy and vaginal delivery is considered by most authors as the first option. Primary cesarean section is preffered in patients with obstructive hydrocephalus or rapid deterioration in the case of shunt malfunction. Epidural anesthesia or general, eventually spinal anesthesia are recommended.

Keywords:
hydrocephalus, shunt, ventriculoperitoneal shunt, ventriculoatrial shunt, endoscopy, endoscopic third ventriculostomy, pregnancy

Sources

1. 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), p. 448–460.

2. Cusimano, MD., Meffe, FM., Gentili, F., Sermer, M. Mana-gement of pregnant women with cerebrospinal fluid shunts. Pediatr Neurosurg, 1991–1992, 17, p. 10–13.

3. Dandy, WE. Extirpation of the choroid plexus of the lateral ventricles in communicating hydrocephalus. Ann Surg, 1918, 68(6), p. 569–579.

4. Fletcher, H., Crandon, IW., Webster, D. Maternal hydrocephalus in pregnancy and delivery: A report of two cases. West Indian Med J, 2007, 56, p. 558–559.

5. Hwang, SC., Kim, TH., Kim, BT., et al. Acute shunt malfunction after cesarean section delivery: a case report. J Korean Med Sci, 2010, 25, p. 647–650.

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

7. Liakos, AM., Bradley, NK., Magram, G., Muszynski, C. 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), p. 69–88.

8. Littleford, JA., Brockhurst, NJ., Bernstein, EP., Georgoussis, SE. Obstetrical anesthesia for a parturient with a ventriculoperitoneal shunt and third ventriculostomy. Can J Anaesth, 1999, 46(11), p. 1057–1063.

9. Monfared, AH., Koh, KS., Apuzzo, ML., Collea, JV. Obstetric management of pregnant women with extracranial shunts. Can Med Assoc J, 1979, 120(5), p. 562–563.

10. 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), p. 339–342.

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

12. 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, p. 19–26.

13. Okagaki, A., Kanzaki, H., Moritake, K., Mori, T. Case report: Pregnant woman with ventriculoperitoneal shunt to treat hydrocephalus. Asia Oceania J Obstet Gynaecol, 1990, 16, p. 111–113.

14. Riffaud, L., Ferre, JC., Carsin-Nicol, B., Morandi, X. Endoscopic third ventriculostomy for the treatment of obstructive hydrocephalus during pregnancy. Obstet Gynecol, 2006, 108, p. 801–804.

15. Sova, M., Smrčka, M., Baudyšová, O., Gogela, J. Management of a shunt malfunction during pregnancy. Bratisl Lek Listy, 2001, 102, p. 562–563.

16. Surov, A., Koman, G., Behrmann, C., et al. A rare cause of ventriculoatrial shunt malfunction. Clin Neurol Neurosurg, 2009, 111, p. 310–311.

17. Wang, X., Wang, H., Fan, Y., et al. Management of acute hydrocephalus due to pregnancy with ventriculoperitoneal shunt. Arch Gynecol Obstet, 2013, 288, p. 1179–1182.

18. 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), p. 827–831.

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

20. Zabramski, JM., Preul, MC., Debbins, J., McCusker, DJ. 3T magnetic resonance imaging testing of externally programmable shunt valves. Surg Neurol Int, 2012, 3, p. 81.