Chiari and syringomyelia; pregnancy and labour; evidence and anecdote
James van Dellen
In the intriguing topic of Chiari and syringomyelia there is, as yet, an unexplored aspect and that is the circumstances surrounding pregnancy and parturition. There is a female dominance with Chiari and there would be understandable concern, in female patients diagnosed with Chiari or syringomyelia, regarding their falling pregnant and the effects that this would have upon them. The default advice is largely to consider family planning very carefully, and some women are even advised to avoid falling pregnant altogether. There are many who would not be aware that they have Chiari or syringomyelia and who have had children before they were first diagnosed. There are also those who are, very exceptionally, diagnosed during pregnancy and, extremely rarely, during parturition. Such instances are without recorded scientific case reports of any adverse events but more likely simply anecdotal statements of concern. There are case reports and small series of reports on delivery practices with Chiari/syringomyelia mothers-to-be, with the vast majority taking a default position of advising elective Caesarean section. Again there are anecdotal case descriptions, not scientifically recorded, of 'misadventures' with parturition and pain control. Litigation consequences are the main concern. The conundrum persists but, as yet, very few substantive reports exist; a conundrum because a normal vaginal delivery might reasonably be regarded as the ultimate Valsalva manoeuvre. In terms of current views regarding the mechanisms of origin and symptom production from Chiari and syringomyelia, we must ask ourselves, how do pregnancy and parturition stack up against these theories?
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.