Moyamoya disease and pregnancy: case reports and criteria for successful vaginal delivery

Sei, Kiguna; Sasa, Hidenori; Furuya, Kenichi

doi:10.1002/ccr3.199

Cited by 14 publications

(6 citation statements)

References 13 publications

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“…For patients who do not respond to medical treatment, surgical options could be offered which include direct revascularization and indirect revascularization procedures. Elective cesarean section is the most chosen mode of delivery [5]; however, if vaginal delivery is opted, assisted delivery methods should be undertaken to avoid Valsalva during the bearing down.…”

Section: Discussionmentioning

confidence: 99%

Successful Regional Anesthetic for a Parturient with Moyamoya Syndrome

Pasam

Kamath

et al. 2020

Case Reports in Anesthesiology

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Anesthesia for Cesarean section could be challenging due to the physiological changes during pregnancy, but it can be more complicated if associated with sickle cell disease and moyamoya disease. The moyamoya syndrome is nothing but sickle cell disease complicated by cerebral vasculopathy. Incidence of moyamoya disease in the USA is 0.086/100,000 people. We report a case of a pregnant woman with sickle cell disease and moyamoya syndrome, who underwent a successful spinal epidural for primary cesarean section, with careful monitoring of blood pressure.

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Section: Discussionmentioning

confidence: 99%

Successful Regional Anesthetic for a Parturient with Moyamoya Syndrome

Pasam

Kamath

et al. 2020

Case Reports in Anesthesiology

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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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“…Some reports advocated vaginal delivery with epidural anesthesia or natural delivery. [23][24][25] However, considering the high occurrence rate of HDP in MMD patients, we are considering that CS should be the first choice for delivery, as blood pressure can be controlled more precisely during CS than during other delivery methods.…”

Section: Discussionmentioning

confidence: 99%

Clinical characteristics of the pregnancies and deliveries of patients with moyamoya disease: A single-center analysis over three decades

Aoyama

Nariai

Moriyama

et al. 2020

International Journal of Stroke

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Background and aims As moyamoya disease in pregnancy is clinically rare, it is poorly understood. We therefore analyzed our experiences of moyamoya disease pregnancies and deliveries over three decades. Methods The clinical data of 78 pregnancies and 77 deliveries among 62 moyamoya disease cases at Tokyo Medical and Dental University Hospital from 1991 to 2019 were retrospectively reviewed. Results There were six, 17 and 55 pregnancies in the first, second, and last decades, respectively. The mean patient age at delivery was 29.3 ± 5.0 years. The primary symptoms of moyamoya disease at diagnosis were ischemia in 50 cases (64.1%) and intracranial hemorrhage in eight cases (10.2%). Cesarean section was performed in 75 cases (96.2%). Fifteen pregnancies (19.2%) developed hypertensive disorders of pregnancy; of these, 13 (86.7%) developed hypertensive disorders of pregnancy after 34 weeks of gestation and 9 (60%) required emergency cesarean section because of a sudden increase in blood pressure. Four (5.1%) women experienced renal artery stenosis complications and three of them developed hypertension during pregnancy. Two (2.6%) experienced cerebral infarctions several days after delivery, both of whom had no subsequent aftereffects. No cases of hemorrhagic stroke were reported in the peripartum period. Conclusions To date, this is the largest single-center analysis. It showed the number of moyamoya disease pregnancies has risen rapidly over the last decade. The hypertensive disorders of pregnancy and emergency cesarean section rates were high among moyamoya disease patients. Minor ischemic stroke was observed, but its prevalence was low. Therefore, pregnant women with moyamoya disease should be managed with the understanding that hypertensive disorders of pregnancy is a common complication.

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Moyamoya disease and pregnancy: case reports and criteria for successful vaginal delivery

Cited by 14 publications

References 13 publications

Successful Regional Anesthetic for a Parturient with Moyamoya Syndrome

Successful Regional Anesthetic for a Parturient with Moyamoya Syndrome

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

Clinical characteristics of the pregnancies and deliveries of patients with moyamoya disease: A single-center analysis over three decades

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