Management of pregnancy and delivery of a patient with malfunctioning ventriculoperitoneal shunt

Abstract

The use of ventriculoperitoneal shunts increased the life expectancy of many women with hydrocephalus who are able to reach childbearing age. It is believed that pregnancy may be associated with shunt malfunction and the management of pregnant women with a malfunctioning ventriculoperitoneal shunt is a challenging medical condition for the anaesthetist, the obstetrician and the neurosurgeon. We report on a case of a 35-year-old primiparous woman who underwent a scheduled caesarean delivery at 30 weeks’ gestation due to deteriorating neurological condition during pregnancy. The patient had a history of astrocytoma resection in the past and placement of a ventriculoperitoneal shunt due to obstructive hydrocephalus. She had a normal life without neurological deficits until the 18th week of gestation, when the first neurological symptoms appeared. An MRI was done that showed significant dilatation of the fourth ventricle and it was believed that the shunt was not functioning properly so the patient's symptoms were present because of raised intracranial pressure. In the 30th week of gestation, she had a caesarean delivery under epidural anaesthesia and she gave birth to a live female infant. Her neurological condition started improving 48 h after delivery and the symptoms gradually regressed. At 20 days after surgery she was discharged from hospital. The presence of a ventriculoperitoneal shunt is not a contraindication for pregnancy. Maternal shunt dependency carries a relatively high incidence of complications for some patients, e.g. shunt malfunction due to raised intraabdominal pressure caused by the gravid uterus. The results of pregnancies and deliveries in women with pre-existing ventriculoperitoneal shunts are favourable if there is proper management.

Keywords::

• Anaesthesia
• caesarean section
• epidural anaesthesia
• intracranial hypertension
• spinal anaesthesia
• ventriculoperitoneal shunt

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.