Pregnancy and labour in women with spina bifida

Abstract

Purpose: In general fertility is not reduced in women with spina bifida. Hormonal contraception is more difficult, due to an increased risk of thrombosis in women with paraplegia. Thus pregnancies of women with spina bifida are possible. The literature does not provide any larger cohorts showing the evidence-based obstetrical management of such pregnancies. Patients: We present five pregnancies in four women out of 180 patients of our spina bifida outpatient clinic. Results: Only one of five pregnancies did not come to term and none of the five fetuses had a neural tube defect (appropriate folic acid prophylaxis was only taken in 3 pregnancies). The two mothers with shunted hydrocephalus experienced no complications with their shunting devices during pregnancy or labor. Urinary tract infections were a major problem only in one woman who had a single kidney and who had suffered from severe urinary tract infections before pregnancy. Intermittent catheterization was performed in three women during their pregnancies without complications. None of the women required antihypertensive drugs during pregnancy. All full-term newborns were born by cesarean section and experienced no peripartual problems. After birth the infants were cared for by their father (two children) or their grandparents. Conclusions: Before planning to become pregnant, genetic counseling should provide information on the risk of recurrence for neural tube defects (about 4%). Folic acid prophylaxis was not taken regularly even in this high-risk group. The rate of abortions in pregnancies of mothers with spina bifida is not well documented in the literature due to a lack of larger cohorts. In our cohort the low rate of urological and shunt-related complications was remarkable. Care of pregnant women with spina bifida during pregnancy and labor must be given on an individual basis, because of the complexity of the problems (different mobility, the presence of a CSF-shunting valve, urological situation with neurogenic bladder and different methods of bladder emptying). Pregnancy and labor as well as postnatal care of the infant are new tasks for spina bifida outpatient clinics. New forms of cooperation with obstetrical departments will have to be established to solve the demanding medical and social problems. (copyright) Georg Thieme Verlag KG Stuttgart.