Management of pregnant women with cerebrospinal fluid shunts.

As more women with cerebrospinal fluid shunts reach child-bearing age, neurosurgeons, obstetricians and other health care providers will increasingly be called upon to care for them once they become pregnant. A review of the literature reveals that these patients may develop symptoms of shunt malfunction as uterine size increases. In most cases, symptoms can be managed conservatively during pregnancy and usually resolve following delivery. The presence of a CSF shunt per se, is not a contraindication to pregnancy and eventual fetal and maternal outcome has been excellent in the majority of cases. Labor and delivery should be allowed to progress naturally and interventions limited to those indicated for obstetrical reasons alone. Peripartum prophylactic antibiotics may be indicated and special care ought to be exercised if epidural analgesia or cesarian section is deemed necessary. Genetic investigations and counseling may be indicated in selected patients.