Al-Saadi Tariq Dhiyab, Glisic Marija, Al Sharqi Ali, Al Kharosi Safiya, Al Shaqsi Malik, Al Jabri Noor, Al Sharqi Awahir
Department of Neurology and Neurosurgery, Montreal Neurological Institute, Montreal/Quebec, Canada; Department of Neurosurgery, Khoula Hospital, Muscat, Sultanate of Oman.
Leibniz Institute for Prevention Research and Epidemiology, Achterstrate Bremen, Deutschland, Germany.
Neurol India. 2020 May-Jun;68(3):548-554. doi: 10.4103/0028-3886.288995.
To assess the safety of pregnancy in ventriculoperitoneal (VP) shunt-dependent women.
Three electronic databases MEDLINE (PubMed), EMBASE, and the Cochrane Library were systematically searched to identify studies published in English between 1950 and 2019. We additionally searched Web of Science, Google Scholar, and ClinicalTrials.gov.
Among the 38 cases of pregnant VP shunt-dependent women, median age was 25.5 years and shunting duration was 15.5 years with 11 women being shunted at birth or soon after. Congenital diseases were the most common reason for shunting, present in 63.2% of women. The antepartum complications were reported in 50% of cases with the symptoms of increased ICP being the most commonly reported (73.7%). In the majority of cases the complications were resolved with cerebrospinal fluid aspiration (26.3%). Eight women (42.1%) had spontaneous vaginal delivery, 4 had assisted vaginal delivery, while 7 women underwent cesarian section. There was one fetal demise occurred in a woman that was diagnosed with tuberous sclerosis and presented with status epilepticus during the pregnancy.
A multidisciplinary approach is needed in managing the VP shunts during the pregnancy and post-partum periods to ensure the best pregnancy outcome for both mothers and the fetus. Based on our findings, VP shunt appears not to be a contraindication for pregnancy. The routine use of prophylactic antibiotics to prevent shunt infection is not recommended. Vaginal delivery should be attempted unless a cesarean section is inevitably required for obstetrics reasons.
评估依赖脑室腹腔（VP）分流术的女性怀孕的安全性。
系统检索三个电子数据库MEDLINE（PubMed）、EMBASE和Cochrane图书馆，以识别1950年至2019年期间以英文发表的研究。我们还检索了科学网、谷歌学术和ClinicalTrials.gov。
在38例依赖VP分流术的怀孕女性中，中位年龄为25.5岁，分流持续时间为15.5年，11名女性在出生时或出生后不久即接受分流。先天性疾病是分流最常见的原因，63.2%的女性存在该情况。50%的病例报告了产前并发症，最常报告的症状是颅内压升高（73.7%）。在大多数病例中，并发症通过脑脊液抽吸得以解决（26.3%）。8名女性（42.1%）自然阴道分娩，4名女性接受助产阴道分娩，7名女性接受剖宫产。一名诊断为结节性硬化症且在孕期出现癫痫持续状态的女性发生了1例胎儿死亡。
在孕期和产后管理VP分流术需要多学科方法，以确保母亲和胎儿获得最佳妊娠结局。根据我们的研究结果，VP分流术似乎不是怀孕的禁忌症。不建议常规使用预防性抗生素来预防分流感染。除非因产科原因不可避免地需要剖宫产，否则应尝试阴道分娩。
