Pikovsky Margaret, Yu Christina
Department of Obstetrics and Gynaecology, St Mary's Hospital, London, UK.
Obstet Med. 2022 Mar;15(1):65-67. doi: 10.1177/1753495X20975941. Epub 2020 Dec 29.
Mode of delivery and intrapartum analgesia for women with Chiari I malformation pose a challenge to the obstetrician and anaesthetist. Clinicians often advocate caesarean section delivery under general anaesthetic to prevent an uncontrolled rise in intracranial pressure or a fall in cerebrospinal fluid pressure during labour that may result in neurological complications, or rarely, brainstem herniation. This case report discusses a woman with hitherto undiagnosed Chiari I malformation who delivered by CS due to obstetric concerns, but remained asymptomatic throughout the preceding labour and in spite of multiple epidural insertion attempts. We discuss considerations for future pregnancies, and review the literature to challenge the view that women with Chiari I need planned caesarean or must avoid epidural/spinal analgesia; instead presenting evidence to support the safety and suitability of vaginal delivery and neuroaxial block in labouring parturients with this condition.
对于患有 Chiari I 畸形的女性，分娩方式和产时镇痛给产科医生和麻醉医生带来了挑战。临床医生通常主张在全身麻醉下进行剖宫产，以防止分娩期间颅内压不受控制地升高或脑脊液压力下降，这可能导致神经并发症，或极少情况下出现脑干疝。本病例报告讨论了一名此前未被诊断出患有 Chiari I 畸形的女性，她因产科问题接受了剖宫产，但在分娩前整个过程中均无症状，尽管多次尝试硬膜外穿刺。我们讨论了对未来妊娠的考虑，并回顾文献以挑战 Chiari I 畸形女性需要计划剖宫产或必须避免硬膜外/脊髓镇痛的观点；相反，我们提供证据支持患有这种疾病的产妇在分娩时进行阴道分娩和神经轴阻滞的安全性和适用性。
