Department of Neurology, Division of Women's Neurology, the Department of Neurology, and the Departments of Anesthesiology and Bioengineering, McGowan Institute for Regenerative Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; the Department of Neurology, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts; and the Department of Bioengineering, University of Pittsburgh, and the Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Maternal-Fetal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
Obstet Gynecol. 2018 Nov;132(5):1180-1184. doi: 10.1097/AOG.0000000000002943.
To estimate whether vaginal delivery or neuraxial anesthesia poses a risk of neurologic deterioration in women with uncorrected Chiari I malformation.
To assemble this case series, electronic record databases were used to identify women with Chiari I malformation who delivered on two busy tertiary care obstetric services over a 5-year period from January 2010 through December 2015. Women who had undergone surgical decompression were not included in the study. The size of the Chiari malformation, neurologic symptoms before delivery, mode of delivery, anesthetic method used, and neurologic complications were recorded.
Ninety-five deliveries in 63 patients were identified. The size of the Chiari malformation was 9.3±4.3 mm (mean±SD). In 58 pregnancies, women reported no headaches; in 36 they did. There was no association between the size of the Chiari malformation and the incidence of headache. Forty-four neonates were delivered by cesarean delivery and 51 were delivered vaginally. No neurologic deterioration occurred in either group. Neuraxial anesthesia was administered before 62 deliveries. No neurologic complications occurred. None of the women who delivered vaginally or received neuraxial anesthesia had signs of increased intracranial pressure. The upper limit of the 95% CI for the risk of neurologic complications from our study of 95 deliveries was 3.1%.
This case series support that in patients with Chiari I malformation who have no signs of increased intracranial pressure, the mode of delivery should be based on obstetric rather than neurologic considerations. The absence of complications in patients who received epidural or spinal anesthesia suggests that these procedures should be made available to women with Chiari I malformation.
评估未经矫正的 Chiari I 畸形女性行阴道分娩或脊麻对神经功能恶化的影响。
为了进行这项病例系列研究，我们使用电子病历数据库，确定了在 2010 年 1 月至 2015 年 12 月的 5 年间，在两家繁忙的三级保健产科服务机构分娩的 Chiari I 畸形女性。未行手术减压的患者不包括在研究中。记录 Chiari 畸形的大小、分娩前的神经症状、分娩方式、使用的麻醉方法和神经并发症。
共发现 63 例患者的 95 例分娩。Chiari 畸形的大小为 9.3±4.3mm（平均值±标准差）。58 例妊娠女性报告无头痛，36 例有头痛。Chiari 畸形的大小与头痛的发生率之间没有关联。44 例新生儿行剖宫产，51 例经阴道分娩。两组均未发生神经功能恶化。62 例分娩前使用了脊麻。未发生神经并发症。经阴道分娩或接受脊麻的女性均未出现颅内压升高的迹象。95 例分娩的研究中，神经并发症风险的 95%CI 上限为 3.1%。
这项病例系列研究表明，对于没有颅内压升高迹象的 Chiari I 畸形患者，分娩方式应基于产科考虑，而非神经科考虑。接受硬膜外或脊髓麻醉的患者无并发症，表明应向 Chiari I 畸形女性提供这些程序。
