Safety of Pregnancy in Ventriculoperitoneal Shunt Dependent Women: Meta-analysis and Systematic Review of the Literature.

OBJECTIVE

To assess the safety of pregnancy in ventriculoperitoneal (VP) shunt-dependent women.

METHODS

Three electronic databases MEDLINE (PubMed), EMBASE, and the Cochrane Library were systematically searched to identify studies published in English between 1950 and 2019. We additionally searched Web of Science, Google Scholar, and ClinicalTrials.gov.

RESULTS

Among the 38 cases of pregnant VP shunt-dependent women, median age was 25.5 years and shunting duration was 15.5 years with 11 women being shunted at birth or soon after. Congenital diseases were the most common reason for shunting, present in 63.2% of women. The antepartum complications were reported in 50% of cases with the symptoms of increased ICP being the most commonly reported (73.7%). In the majority of cases the complications were resolved with cerebrospinal fluid aspiration (26.3%). Eight women (42.1%) had spontaneous vaginal delivery, 4 had assisted vaginal delivery, while 7 women underwent cesarian section. There was one fetal demise occurred in a woman that was diagnosed with tuberous sclerosis and presented with status epilepticus during the pregnancy.

CONCLUSION

A multidisciplinary approach is needed in managing the VP shunts during the pregnancy and post-partum periods to ensure the best pregnancy outcome for both mothers and the fetus. Based on our findings, VP shunt appears not to be a contraindication for pregnancy. The routine use of prophylactic antibiotics to prevent shunt infection is not recommended. Vaginal delivery should be attempted unless a cesarean section is inevitably required for obstetrics reasons.