Pregnancy complicated by neurological and neurosurgical conditions – The evidence regarding mode of delivery

Abstract

Neurological and neurosurgical conditions complicating pregnancy may precipitate considerable concern regarding the risk of complications, and uncertainty regarding the preferred mode of delivery and anaesthesia. Caesarean section is known to be associated with significantly increased risk of adverse maternal outcomes compared with vaginal delivery in healthy pregnancy. Nevertheless, a common perception exists among the general population and some health professionals that caesarean section is safer for the mother and baby in high-risk pregnancies. This manuscript examines the literature regarding the risks and outcomes related to mode of delivery in pregnancy complicated by disorders of the central nervous system. With the exception of women with raised intracranial pressure, and some women with Von Hippel-Lindau syndrome, the available evidence suggests that the mode of delivery should be based upon obstetric indications.

Neurological Complications in Pregnancy and the Puerperium: Methodology for a Clinical Diagnosis

“…It can be reasonable to begin the prophylaxis of the antenatal corticosteroid between 24 and 32 weeks of gestation, aiming for a controlled induction of labor between 34 and 39 weeks. Cesarean sections should be avoided [108].…”

“…In other chronic neurosurgical and neurological disorders, the available evidence suggests the mode of delivery should be based upon obstetric indications. Large prospective studies assessing maternal and fetal outcomes are needed to establish guidelines regarding the preferred mode of delivery with neurosurgical and neurological conditions [108]. Figure 3 presents a brief and useful algorithm to follow in the above-mentioned clinical situation.…”