Spina bifida in pregnancy: A review of the evidence for preconception, antenatal, intrapartum and postpartum care

Sivarajah, Kenga; Relph, Sophie; Sabaratnam, Radha; Bakalis, Spyros

doi:10.1177/1753495x18769221

Cited by 13 publications

(6 citation statements)

References 46 publications

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“…A review by Sivarajah et al noted that epidural anesthesia in patients with spina bifida occulta is often uneventful. However, spinal cord injury is possible without MRI imaging confirmation if tethered cord syndrome is present [ 15 ]. Indeed, spinal cord injuries due to neuraxial anesthesia in pregnant women with undiagnosed latent spina bifida and tethered cord syndrome have been reported [ 16 , 17 ].…”

Section: Discussionmentioning

confidence: 99%

Anesthesia outcomes of pregnant women with spinal diseases: a single-center case-series study

Yakhup,

Okada,

Kawagoe

et al. 2023

JA Clin Rep

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Background Neuraxial anesthesia is widely used as the most effective and standard method in obstetric anesthesia. However, there is a concern that neuraxial anesthesia may be technically difficult or ineffective in pregnant women with spinal disease. Therefore, this study aimed to investigate the implementation rate of neuraxial anesthesia among pregnant women with spinal diseases and their success rate at our institution. Methods The subjects of this study were pregnant patients who delivered at Juntendo University Nerima Hospital between April 2017 and December 2020. After obtaining ethics committee approval, data were collected from patients’ medical records. Results Of the 2682 pregnant women who delivered, 1550 underwent preanesthetic evaluation. There were 42 deliveries in 39 pregnant women with spinal diseases (1.7% of all pregnant women and 2.7% of those who underwent preanesthetic evaluation). The diagnoses included adolescent idiopathic scoliosis (51.3%), lumbar disc herniation (23.1%), and others. The mode of delivery was the elective cesarean section in 5 cases, emergent cesarean section in 8 cases, and vaginal delivery in 29 cases. Only one case required general anesthesia. Of the 38 cases of labor analgesia, the neuraxial block was inadequate in 3 cases (7.9%) and technically difficult in 3 cases (7.9%). However, the patients complained of no lower extremity neuropathy, infection, or inadvertent dural puncture. Discussion Neuraxial anesthesia was an option in most cases, even in pregnant women complicated with spinal disease, if an anesthesiologist’s plan before delivery after careful preanesthetic evaluation.

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Section: Discussionmentioning

confidence: 99%

Anesthesia outcomes of pregnant women with spinal diseases: a single-center case-series study

Yakhup,

Okada,

Kawagoe

et al. 2023

JA Clin Rep

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“…population have been associated with increased rates of C-section, which may provide a partial explanation for this nding [10,11]. Additionally, limited range of motion due to orthopedic deformities can make proper positioning required for vaginal delivery unsuitable for this patient population [12]. Furthermore, neurogenic bladder requiring urological procedures is very common among S.B.…”

Section: Discussionmentioning

confidence: 99%

Pregnancy in spina bifida patients: a comparative analysis of peripartum procedures and complications

et al. 2022

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Spina Bi da (S.B.) is caused by a failure in neural tube closure that can present with lower extremity sensory de cits, paralysis, and hydrocephalus. Medical advances have allowed increased pregnancies among S.B. patients, but management and pregnancy-associated complications have not been thoroughly investigated. The objective is to delineate peripartum procedures and complications in patients with S.B. MethodsA national de-identi ed database, TriNetX, was retrospectively queried to evaluate pregnant S.B. patients and the general population. Procedures and complications were investigated using corresponding ICD-10 and CPT codes within 1 year of pregnancy diagnosis. Results 11,405 SB patients were identi ed and compared to 9,269,084 non-S.B. patients. SB patients were signi cantly more likely to undergo cesarean delivery (1.200; 95% CI [1.133-1.271]) and less likely to receive neuraxial analgesia (0.406; 95% CI [0.383-0.431]). Additionally, patients with SB had an increased risk of seizures (3.922; 95% CI [3.529-4.360]) and venous thromboembolism (VTE) (3.490; 95% CI [3.070-3.969]). Risks of pre-eclampsia and hemorrhage were comparable. S.B. patients with hydrocephalus and Chiari malformation type 1 (CM-1) or type 2 (CM-2) were compared to patients without these comorbid conditions. This sub-group analysis showed a signi cantly increased risk of having cesarean deliveries (S.B. with hydrocephalus: 12.55%, S.B. with CM-1 or CM-2: 12.81% vs. S.B. without hydrocephalus or CM: 6.16%) and VTE (3.74%, 2.43% vs. 0.81%). There were also increased risks of hemorrhage and seizures and decreased use of neuraxial analgesia, but the sample size was insu cient. ConclusionS.B. patients were more likely to undergo cesarean section and exhibit peripartum complications compared to those without S.B. to coding errors. Patient-level information regarding speci c diagnostic tests and radiographic information was not provided to con rm disease, gravida, medications, and insurance status. Risks of peripartum outcomes may vary depending on the level of defect. As a database study, our study relies on the accuracy of each health care organization's CPT and ICD 10 coding, which is a potential source of inaccurate or incomplete reporting. Further limitations include the data source is restricted to healthcare organizations in the United States that participate in the database retrieval system. Mothers with S.B. were more likely to have a c-section and exhibit peripartum complications compared to those without S.B. Further studies are needed so that multidisciplinary care teams can address the complexity of conditions in S.B. mothers to provide optimal comprehensive peripartum care.

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“…Furthermore, although renal dysplasia is often asymptomatic, hypertension can be caused by vascular malformation [13]. in the process of embryonic development, the skeletal muscle system was also homologous with the urogenital system that originated from the mesoderm, and the development time is also in the early embryo [14][15][16][17][18].…”

Section: Discussionmentioning

confidence: 99%

Association of neural tube defects with congenital abnormalities of the urogenital system in a Chinese cohort

Hong¹,

Jin²,

Yuan³

et al. 2021

BMC Pediatr

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Background This study aimed to retrospectively analyze the correlation between congenital abnormality of the urogenital system and various factors in children with neural tube defects (NTDs). Methods A total of 190 children with congenital NTDs, who were admitted to a hospital from May 2013 to May 2018, were included into the present study. All admitted children with congenital NTDs were carried out routine abdominal B-ultrasound examinations to determine the malformations of the abdominal organs, including the urinary system. Children with a B-ultrasound result of suspected and unsure malformation underwent intravenous pyelography (IVP) and voiding cysto-urethrography (VCU), and this was further confirmed by the CT results. Results The incidence of urogenital malformation was 12.1% (23/190) in children with congenital NTDs. For the 23 children with urogenital malformations, most of these children had no definite urinary system symptoms, while some of these children had multiple incidences of urinary system infections. Conclusions Congenital NTDs are often combined with urogenital malformations, if not specifically searched these may be overlooked. The early detection of these malformations is beneficial to reduce the risk of operation and improve the prognosis.

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Spina bifida in pregnancy: A review of the evidence for preconception, antenatal, intrapartum and postpartum care

Cited by 13 publications

References 46 publications

Anesthesia outcomes of pregnant women with spinal diseases: a single-center case-series study

Anesthesia outcomes of pregnant women with spinal diseases: a single-center case-series study

Pregnancy in spina bifida patients: a comparative analysis of peripartum procedures and complications

Association of neural tube defects with congenital abnormalities of the urogenital system in a Chinese cohort

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