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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, 230 . pp. 1-5. doi:10.1016/j.ejogrb.2018.09.006

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Official URL: http://dx.doi.org/10.1016/j.ejogrb.2018.09.006

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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
Subjects: R Medicine > RC Internal medicine
R Medicine > RG Gynecology and obstetrics
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
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: 1 November 2018
Dates:
DateEvent
1 November 2018Published
10 September 2018Available
8 September 2018Accepted
Volume: 230
Page Range: pp. 1-5
DOI: 10.1016/j.ejogrb.2018.09.006
Status: Peer Reviewed
Publication Status: Published
Access rights to Published version: Restricted or Subscription Access

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