Pregnancy in Patients with Spina Bifida and Urinary Diversion

Natarajan, Vasanthi; Kapur, Dhriti; Sharma, Shaveta; Singh, G.

doi:10.1007/s001920200085

Cited by 20 publications

(7 citation statements)

References 22 publications

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“…Pregnancy outcomes are generally good, with some reports of congenital abnormalities [Natarajan et al, 2002].…”

Section: Sexuality and Reproductive Issuesmentioning

confidence: 99%

Optimizing health care for adults with spina bifida

Webb

2010

Dev Disabil Res Revs

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Survival into adulthood for individuals with spina bifida has significantly improved over the last 40 years with the majority of patients now living as adults. Despite this growing population of adult patients who have increased medical needs compared to the general population, including spina bifida (SB)-specific care, age-related secondary disabilities, and general adult medical needs, there is little published information about the natural history of SB in adulthood. There are few published studies of medical conditions, interventions, or long-term complications in this population. This article will provide a review of the medical issues of adults with SB, highlighting areas that are different than pediatric care, and areas of needed research.

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“…Pregnancy outcomes are generally good, with some reports of congenital abnormalities [Natarajan et al, 2002].…”

Section: Sexuality and Reproductive Issuesmentioning

confidence: 99%

Optimizing health care for adults with spina bifida

Webb

2010

Dev Disabil Res Revs

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“…Natarajan et al (2002) report a delivery by caesarean section in a patient with a Mitrofanoff. Natarajan et al (2002) report a delivery by caesarean section in a patient with a Mitrofanoff.…”

Section: Discussionmentioning

confidence: 94%

Clinical challenges of diagnosing a perforated appendix in pregnancy: two illustrative cases

Somoye

Downes

2004

Journal of Obstetrics and Gynaecology

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Case 1A 30-year-old woman with a previous spontaneous term delivery and one miscarriage was admitted into the labour ward at 27 weeks' gestation. Her antenatal course until then had been uneventful. She complained of a 1-day history of right-sided abdominal pain, backache, vomiting and diarrhoea, having felt non-specifically J Obstet Gynaecol Downloaded from informahealthcare.com by Technische Universiteit Eindhoven on 11/17/14For personal use only.Obstetric case reports 577 J Obstet Gynaecol Downloaded from informahealthcare.com by Technische Universiteit Eindhoven on 11/17/14For personal use only.

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“…Natarajan et al (2002) report a delivery by caesarean section in a patient with a Mitrofanoff. Schumacher et al (1997) report a series of patients with a Mainz pouch urinary diversion all of whom underwent caesarean section.…”

Section: Discussionmentioning

confidence: 97%

Vaginal delivery in a patient with spina bifida and a Mitrofanoff urinary diversion

Roberts

Rafferty

2004

Journal of Obstetrics and Gynaecology

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Case reportA 21-year-old primigravida with spina bifida conceived spontaneously. She was born with an open lumbar meningomyelocoele which was closed 2 days after birth. A shunt was inserted for hydrocephalus when she was 3 weeks old. Neurologically she had full use of her upper arms and full hip movement but was wheelchair-bound due to lower limb paralysis and paraesthesia. A Mitrofanoff procedure, whereby the reversed vascularised appendix is used as a cutaneous stoma, was performed at the age of 17 for a neurogenic bladder. She was performing clean intermittent selfcatheterisation (CISC) through an umbilical stoma.During the antenatal period she had recurrent urinary tract infections. Coliform species were isolated and treated. It was decided not to put her on prophylactic antibiotics due to the risk of antibiotic resistance. During the third trimester she had increasing difficulty performing CISC resulting in an indwelling catheter being inserted. A renal tract scan showed bilateral hydronephrosis with dilatation of the proximal ureters. Renal function remained normal.It was decided to perform an elective caesarean section at 38 weeks under general anaesthetic as a combined procedure with the urologists. However, at 35 weeks she ruptured her membranes and went into labour spontaneously. Labour progressed quickly and she had a forceps delivery due to impaired voluntary bearing down in the second stage. A male infant weighing 2.6 kg was delivered in good condition.She made an uneventful recovery and was able to resume CISC through her stoma. Anticoagulation with prophylactic low molecular weight heparin was prescribed for 6 weeks postnatally due to her immobility. DiscussionMany more women with spina bifida are achieving successful pregnancies due to improved neurosurgical and urological corrective procedures. The application of CISC to continent abdominal wall stomas has allowed independence for those not able to perform urethral catheterisation. There are reports in the literature of pregnancies after continent urinary diversion. Natarajan et al. (2002) report a delivery by caesarean section in a patient with a Mitrofanoff. Schumacher et al. (1997) report a series of patients with a Mainz pouch urinary diversion all of whom underwent caesarean section. Vaginal delivery has been achieved in patients with a Koch pouch continent stoma (Akerland et al. , 1991). We believe that our case is the first vaginal delivery reported in a patient with a Mitrofanoff procedure.Management of such a high-risk pregnancy and delivery poses a number of interesting challenges. Antenatally, the main problem encountered occurred in the third trimester due to pressure from the gravid uterus causing inadequate conduit drainage.The mode of delivery needs to be assessed on an individual basis. There is an increased incidence of malpresentation, maternal pelvic deformities and fixed adduction deformity of the hips leading to elective caesarean. In women who have had extensive surgery, the risk of having to perform an emergency caesarean s...

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Pregnancy in Patients with Spina Bifida and Urinary Diversion

Cited by 20 publications

References 22 publications

Optimizing health care for adults with spina bifida

Optimizing health care for adults with spina bifida

Clinical challenges of diagnosing a perforated appendix in pregnancy: two illustrative cases

Vaginal delivery in a patient with spina bifida and a Mitrofanoff urinary diversion

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