Meier Kaare, Glavind Julie, Milidou Ioanna, Sørensen Jens Christian Hedemann, Sandager Puk
Department of Neurosurgery, Aarhus University Hospital, Aarhus, Denmark; Department of Anesthesiology, Aarhus University Hospital, Aarhus, Denmark; Center for Experimental Neuroscience, Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark.
Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark.
Neuromodulation. 2023 Jan;26(1):224-232. doi: 10.1016/j.neurom.2022.03.008. Epub 2022 Jun 10.
Spinal cord stimulation (SCS) is a treatment for chronic neuropathic pain. It is based on the delivery of electric impulses to the spinal cord, traditionally in a regular square-wave pattern ("tonic" stimulation) and, more recently, in a rhythmic train-of-five "BurstDR" pattern. The safety of active SCS therapy in pregnancy is not established, and recommendations are based on limited casuistic evidence. We present in this study clinical data on a case series of six women treated with burst SCS during pregnancy. In addition, we present the ultrasonographic flow measurements of fetal and uteroplacental blood flow in a pregnant patient.
Patients were included if they had been implanted with a full SCS system at Aarhus University Hospital, Denmark, between 2006 and 2020 and received active burst SCS stimulation during a pregnancy. Telephone interviews were conducted, including details on SCS therapy, medication, pregnancy course and outcome, and health status of the offspring. In one patient, the uteroplacental and fetal blood flow was assessed in gestational week 29 by Doppler flow measurements performed during both ON and OFF phases of the SCS system.
Six patients were included with a total of 11 pregnancies. Three pregnancies ended in miscarriages, all in the same patient who had preexisting significant risk factors for miscarriage. Eight resulted in a live-born child with normal birth weight for gestational age; seven were born at term, and one was born late preterm, in gestational week 36. Ultrasonographic Doppler flow, measured in one patient, was normal and did not reveal any immediate changes between burst SCS ON and OFF. Seven children were reported healthy with normal neurodevelopment and one physically healthy but with developmental delays.
The data presented in this study add to the accumulating evidence of the safety of SCS in pregnancy.
脊髓刺激（SCS）是一种治疗慢性神经性疼痛的方法。它基于向脊髓传递电脉冲，传统上采用规则的方波模式（“强直”刺激），最近则采用有节奏的五联脉冲串“BurstDR”模式。主动SCS治疗在孕期的安全性尚未确立，相关建议基于有限的个别案例证据。我们在本研究中展示了一组六名在孕期接受脉冲串SCS治疗的女性的临床数据。此外，我们还展示了一名孕妇胎儿及子宫胎盘血流的超声血流测量结果。
纳入2006年至2020年间在丹麦奥胡斯大学医院植入完整SCS系统并在孕期接受主动脉冲串SCS刺激的患者。进行电话访谈，内容包括SCS治疗、用药、妊娠过程及结局，以及后代的健康状况。在一名患者中，于孕29周通过在SCS系统开启和关闭阶段进行的多普勒血流测量评估子宫胎盘和胎儿血流。
纳入六名患者，共11次妊娠。三次妊娠以流产告终，均发生在同一名有明显流产危险因素的患者身上。八次妊娠生出的活产儿出生体重与孕周相符；七名足月出生，一名早产，孕36周出生。在一名患者中测量的超声多普勒血流正常，且未显示脉冲串SCS开启和关闭之间有任何即时变化。七名儿童报告健康，神经发育正常，一名身体健康但有发育迟缓。
本研究提供的数据进一步证明了SCS在孕期的安全性。
