Authors: Erez Nossek Margaret Ekstein Eli Rimon Michael J Kupferminc Zvi Ram
Publish Date: 2011/06/10
Volume: 153, Issue: 9, Pages: 1727-1735
Abstract
Pregnant women with pathological conditions requiring a neurosurgical intervention pose a unique therapeutic challenge Changes in normal physiology add to the complexity of patient management We describe our experience in treating various neurosurgical diseases in parturient womenThirtyfour pregnant and early postpartum women were treated at our center between 2003 and 2010 The general guideline used in these patients now deserving reevaluation based on the presented data was to postpone surgery until the patient reached term weeks 34–38 of gestation unless there was evidence of a life or functionthreatening condition in which case surgery was promptly performedSixteen patients underwent neurosurgical intervention during pregnancy between 11 to 34 weeks of gestation 7 tumor 3 vascular 2 VP shunt 2 spinal 2 trauma Thirteen women underwent a neurosurgical procedure after delivery 12 tumor 1 spine and 5 women were treated conservatively 2 vascular lesions 3 trauma Three patients underwent abortions one spontaneous and two elective The other 31 women delivered at 30–42 weeks gestation Of 12 patients whose definitive neurosurgical procedure was initially delayed 5 were not able to complete their pregnancy naturally Of 21 patients that underwent a cesarean section CS 3 were performed urgently Although two pairs of twins and two singletons had an initial low Apgar score 7 the outcome for all the neonates was good Neurosurgical outcome was satisfactoryOur experience demonstrates the safety of neurosurgical intervention and anesthesia during pregnancy Delaying intervention often resulted in maternal deterioration and urgent intervention Thus pregnancy by itself should not be considered a major contraindication for performing a neurosurgical procedure which should be considered early rather than late in most patients
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