Vaginal delivery in pregnancy with <scp>M</scp>oyamoya disease: Experience at a single institute

Tanaka, Hiroaki; Katsuragi, Shinji; Tanaka, Kayo; Miyoshi, Takekazu; Kamiya, Chizuko; Iwanaga, Naoki; Neki, Reiko; Takahashi, Jun; Ikeda, Tomoaki; Yoshimatsu, Jun

doi:10.1111/jog.12557

Cited by 21 publications

(7 citation statements)

References 14 publications

(18 reference statements)

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“…There are however reported cases of vaginal delivery, the majority performed with epidural anesthesia, and many are operative (assisted) deliveries (Table 1). 7,11–16 No increase in risk of neurologic complications was noted in patients who underwent vaginal delivery in these case series.…”

Section: Discussionmentioning

confidence: 65%

Moyamoya disease in pregnancy and delivery planning: A case series and literature review

Weston

Mehta

2016

Obstet Med

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Moyamoya disease is a rare condition characterized by stenosis or occlusion of the intracranial internal carotid arteries leading to the development of fragile collateral vessels. Disruption of these vessels can lead to both ischemic and hemorrhagic strokes. As such, these patients are sensitive to changes in intracranial pressure and pose a challenge in pregnancy and delivery planning. Two cases of a parturients with moyamoya disease are presented, and the literature regarding safe method of delivery in similar patients is reviewed. The available evidence suggests that adequate anesthesia, and maintenance of hemodynamic status, takes precedence over the exact method of delivery in these patients. Cesarean delivery under epidural anesthesia can be a safe option for parturients with moyamoya disease, but an uncomplicated vaginal delivery, most often assisted with either vacuum or forceps, has also been frequently reported.

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Section: Discussionmentioning

confidence: 65%

Moyamoya disease in pregnancy and delivery planning: A case series and literature review

Weston

Mehta

2016

Obstet Med

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“…The common conclusion across all these studies is that vaginal delivery attempts are possible only when the cerebral blood ow is stable. [3,21] Several limitations should be considered when interpreting the present ndings. First, this study was based on insurance claim data in the KNHI Claims Database, which was designed for cost claim issues, not research.…”

Section: Discussionmentioning

confidence: 94%

The Risk for Future Cerebrovascular Disease in Pregnant Women With Moyamoya Disease: A Nationwide Population-Based Study in South Korea

Jeong

Jung

Noh

et al. 2021

Preprint

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Background: Physiologic changes during pregnancy affect the development of postpartum cerebrovascular disease (CVD) in women with Moyamoya disease (MMD). Due to the rare prevalence of MMD and large regional variations, large-scale studies on the risk of CVD after delivery have not been conducted. The aim of this study was to evaluate whether women with MMD have an increased risk of CVD after delivery.Methods: Research data was collected from the National Health Insurance Claims Database of the Health Insurance Review and Assessment Service. Patients delivered in Korea from 2007 to 2014 were enrolled. We classified women as CVD if they were diagnosed with stroke and/or cerebral infarction and/or intracranial hemorrhage and/or subarachnoid hemorrhage between delivery and December 31, 2016. To evaluate adjusted hazard ratio for CVD in women with MMD, we used multivariate Cox proportional hazard regression.Results: Among 3,611,216 Korean women who had delivery, 382 had Moyamoya disease. When compared to women without MMD, women with MMD had a higher prevalence of pregestational diabetes and chronic hypertension. Also, women with MMD had a significantly higher incidence of cesarean section, pregnancy-induced hypertension, and gestational diabetes mellitus (p<0.0001, <0.0001, 0.02, respectively). Among women with MMD, a total of 246(64.4%) women developed CVD within the follow-up postpartum period, and 87.8% occurred within 2 years of postpartum. Women with MMD were associated with an increased risk of CVD in later (adjusted HR 108.24; 95% CI, 95.37-122.86) after adjusting for maternal age, parity, pregnancy-induced hypertension, gestational diabetes mellitus, pregestational diabetes, chronic hypertension.Conclusion: Our study showed that the incidence of CVD after delivery was higher in women with MMD. Therefore, we have to have more cautions of women with MMD and provide long-term postpartum surveillance

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“…However, studies comparing the results of cesarean section with those of vaginal delivery have not been conducted yet. Several recent studies have investigated whether the stroke risk varies with the delivery method [ 11 , 32 ]. A study concluded that there were no complications with vaginal delivery in pregnant women with Moyamoya disease under epidural anesthesia [ 32 – 34 ].…”

Section: Discussionmentioning

confidence: 99%

The risk for future cerebrovascular disease in pregnant women with Moyamoya disease: a nationwide population-based study in South Korea

Jeong

Jung

Noh

et al. 2022

BMC Pregnancy Childbirth

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Background Physiologic changes during pregnancy affect the development of postpartum cerebrovascular disease (CVD) in women with Moyamoya disease. Due to the rare prevalence of Moyamoya disease and its large regional variations, large-scale based studies on the risk of CVD after delivery have not been conducted. This study aimed to evaluate whether women with Moyamoya disease have an increased risk of CVD after delivery. Methods Research data was collected from the National Health Insurance Claims Database of the Health Insurance Review and Assessment Service. Patients who delivered in Korea from 2007 to 2014 were enrolled in this study. We classified women as having CVD if they were diagnosed with any of the following conditions between delivery and December 31, 2016; cerebral infarction (I63.X in the International Classification of Diseases-10th Revision [ICD-10]) and/or intracranial hemorrhage (I61.X, I62.X in ICD-10) and/or subarachnoid hemorrhage (I60.X in ICD-10). Women with Moyamoya disease were identified as having I67.5 in ICD-10. We matched the study cohort by the ratio of 1:10 to analyze the risk CVD occurrence. The matching technique applied in this study was based on the variables of age and parity. To evaluate the adjusted hazard ratio (HR) for CVD in women with Moyamoya disease, we used multivariate Cox proportional hazard regression. Results Among a total of 3,611,216 Korean women who underwent delivered, we identified 412 women with Moyamoya disease diagnosis and 1420 age- and parity-matched women without Moyamoya disease (control). Compared to the control group, women with Moyamoya disease had a significantly higher rate of Cesarean section, overt DM, and essential hypertension (all p < 0.0001). Among women with Moyamoya disease, 55 (13.35%) women developed CVD within the follow-up postpartum period. The presence of Moyamoya disease was associated with an increased risk of CVD after delivery (adjusted HR 37.42; 95% confidence interval (CI) 17.50-80.02 within 2.3 years) after adjusting for pregnancy-induced hypertension, gestational diabetes mellitus, pregestational diabetes, chronic hypertension. Conclusion This population based study showed that the occurrence rate of CVD after delivery was higher in women with Moyamoya disease than in those without. Therefore, careful and long-term postpartum surveillance is required for women with Moyamoya disease.

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Vaginal delivery in pregnancy with Moyamoya disease: Experience at a single institute

Abstract: Our findings indicate that vaginal delivery is viable in pregnancy with Moyamoya disease and that unnecessary cesarean section may be avoided. These findings are limited by the retrospective nature of the study.

Cited by 21 publications

References 14 publications

Moyamoya disease in pregnancy and delivery planning: A case series and literature review

Moyamoya disease in pregnancy and delivery planning: A case series and literature review

The Risk for Future Cerebrovascular Disease in Pregnant Women With Moyamoya Disease: A Nationwide Population-Based Study in South Korea

The risk for future cerebrovascular disease in pregnant women with Moyamoya disease: a nationwide population-based study in South Korea

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