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Management and birth outcomes of pregnant women with Chiari malformations : a 14 years retrospective case series
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Roper, Joanna C., Al Wattar, Bassel H., Silva, Adikarige Haritha Dulanka, Samarasekera, Shanika, Flint, Graham and Pirie, Alex M. (2018) Management and birth outcomes of pregnant women with Chiari malformations : a 14 years retrospective case series. European Journal of Obstetrics & Gynecology and Reproductive Biology . doi:10.1016/j.ejogrb.2018.09.006 (In Press)
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Official URL: http://dx.doi.org/10.1016/j.ejogrb.2018.09.006
Abstract
Objective
The management of Chiari malformations in pregnancy is challenging due to the perceived risk of adverse maternal neurological outcomes and raising intracranial pressure during labour. Our aim was to evaluate the management and health outcomes of pregnant women cared for at a regional referral center and highlight elements of best practice.
Study Design
A retrospective case series of all pregnant women diagnosed with Chiari malformation over fourteen years (January 2004- June 2018) at the Birmingham Women’s Hospital – UK.
Results
Twenty-one women (23 pregnancies) with Chiari malformation were included, four had syringomyelia (4/21,19%) and six had previously undergone craniovertebral decompression (6/21, 29%). The median age was 34-years (range 20-41), the median gravidity was two (range 1-8), the median parity was one (range 0-6), and the median extent of tonsillar herniation was 11 mm (range 9-18). The majority of women received their preferred mode of delivery (15 normal vaginal deliveries (15/23, 65.2%) and 6 elective Caesarean sections (6/23, 26.1%)) with two pregnancies ending with an emergency caesarean section for obstetric complications (2/23, 8.7%). Five Caesarean section were performed under general anaesthetic, two under spinal (2/23, 8.7%) and one under epidural anaesthesia (1/23, 4.3%) with no neurological sequelae. There were no adverse neurological outcomes at discharge postnatally.
Conclusions
Offering normal vaginal delivery with effective analgesia, for women with Chiari malformation, appears to be safe. Pregnancy care should be provided by a multi-disciplinary team with experience in managing Chiari malformation.
| Item Type: | Journal Article | ||||||
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| Subjects: | R Medicine > RC Internal medicine R Medicine > RG Gynecology and obstetrics |
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| Divisions: | Faculty of Medicine > Warwick Medical School > Biomedical Sciences > Cell & Developmental Biology Faculty of Medicine > Warwick Medical School > Biomedical Sciences Faculty of Medicine > Warwick Medical School |
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| Library of Congress Subject Headings (LCSH): | Obstetrics, Arnold-Chiari deformity, Syringomyelia, Maternal health services | ||||||
| Journal or Publication Title: | European Journal of Obstetrics & Gynecology and Reproductive Biology | ||||||
| Publisher: | Elsevier Ireland Ltd | ||||||
| ISSN: | 0301-2115 | ||||||
| Official Date: | 10 September 2018 | ||||||
| Dates: |
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| Date of first compliant deposit: | 11 September 2018 | ||||||
| DOI: | 10.1016/j.ejogrb.2018.09.006 | ||||||
| Status: | Peer Reviewed | ||||||
| Publication Status: | In Press | ||||||
| Access rights to Published version: | Restricted or Subscription Access |
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