The symposium is co-organised by The Ann Conroy Trust, in association with Aesculap Academia.
The Ann Conroy Trust is Registered Charity No: 1165808.
We provide Support, Education and Research for patients living with Chiari Malformation, Syringomyelia and associated conditions.
F35 Management of pregnancy and delivery in women with Chiari malformation type I and/or syringomyelia : a variability survey.
Knafo S, Picard B, Samadi M, Benhamou D, Parker F.
Management of Chiari malformation type I (CMI) and syringomyelia during pregnancy and delivery remains debatable. The aim of this study was to identify current practices and to investigate whether some of these may have an impact on the natural history of the disease.
A retrospective cohort study of women harbouring CMI and/or syringomyelia, born between 1970 and 2000, and followed by the French National Centre for Chiari and Syringomyelia, in Bicêtre Hospital. Among 311 patients eligible, 99 women with at least one delivery were included in the final analysis.
Seventy percent of patients had two or more deliveries. Forty-one percent had surgery for either CMI and/or syringomyelia. Among these 71% had surgery after their first pregnancy. Sixty-five percent of patients underwent vaginal delivery, 19% had a scheduled Caesarean procedure and 16% underwent emergency section. Only 21% of patients declared that the delivery method was chosen in consultation with their neurosurgeon but amongst these the rate of scheduled Caesarean procedures was 52%. Fifty-nine percent of patients had epidural anaesthesia (38% after neurosurgical advice) and 19% had a general anaesthetic. There were no complications related to pregnancy in 79% of cases. During pregnancy, only 13% of the patients reported a worsening of their symptoms, 68% were unchanged and 10% were improved. After pregnancy, 34% of patients reported some worsening of their symptoms but only 3 patients were diagnosed in the year following their pregnancy. There was no difference regarding the proportion of clinical deterioration between the modalities of delivery or anaesthesia.
The majority of patients harbouring CMI and/or syringomyelia undergo vaginal delivery and epidural anaesthesia without complication. However, when solicited, most neurosurgeons still favour Caesarean procedures under general anaesthesia. A consensus between neurosurgeons, obstetricians and anaesthesiologists would be desirable, to prevent unnecessary Caesarean procedures.