Pregnancy Outcomes in Women with Moyamoya Disease: Experiences at a Single Center in Korea

Abstract

This is an Open Access article distributed under the terms of the Creative Commons Attribution NonCommercial License (http://creativecommons.org/ licenses/by-nc/3.0) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.Purpose: Moyamoya disease (MMD) occurs predominantly in Korean and Japanese women. The aim of this study was to investigate clinical features and pregnancy outcomes in women with MMD. Materials and Methods: We conducted a retrospective chart review of women with MMD who visited our Department of Obstetrics and Gynecology between January 2005 and October 2013. For all study subjects, clinical features, demographic characteristics, and perinatal outcomes were recorded. Results: We identified 28 pregnancies in 22 patients who had been diagnosed with MMD. The mean maternal age at delivery was 31.9±3.5 years old. The mean gestational age at delivery was 38.0±0.9 weeks. Among the 28 pregnancies, 25 (92.5%) underwent cesarean section; 19 (76.0%) of them were performed under regional anesthesia and six (24.0%) under general anesthesia. The mean newborn weight was 3233.7±348.2 g. The 5-minute Apgar score in 85% of the newborns was higher than 8, with no other apparent complications. During the puerperal period, transient ischemic attack symptom or seizure occurred in 4 cases, although patients recovered within a few days. Conclusion: For pregnant women with MMD, it is important to control blood pressure and prevent hyperventilation during the intrapartum period, and the best methods of delivery and anesthesia should be considered to avoid unfavorable sequelae. Additionally, a multidisciplinary approach (i.e., neurosurgery) is necessary to constantly manage underlying diseases.

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

“…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.…”

Transition to Adulthood for Pediatric Moyamoya Patients

“…24 While many centers choose cesarean section as the default method of delivery, healthy vaginal births are certainly possible, with the caveat that pain management (often with an epidural catheter) and avoidance of hyperventilation are crucial. 25 Overall, for moyamoya patients already revascularized, > 95% of mothers with moyamoya disease have good neurological outcomes after pregnancies, with all delivered children reported healthy. 23 In contrast, those females who were newly diagnosed with moyamoya during pregnancy (typically with a new stroke or hemorrhage) typically presented after 24 weeks of gestation, with >10% maternal mortality and >20% fetal death.…”

Primary Intraventricular Hemorrhage in Second Trimester of Pregnancy: A Case Report

“…To the best of our knowledge, the cases where mother had PIVH were reported by few authors like Tamizuddin et al [3], Mehrkens et al [8], Newman and Al-Memar [9], Jung et al [10], except the first, in other 3 cases the cause was known to be moyamoya disease. However in the first case it is of unknown etiology.…”

“…Jayakumar et al reported 70% mortality with pan ventricular blood [1,3]. However patients with PIVH of unknown cause have better prognosis than those with a documented mechanism of hemorrhage (secondary intraventricular hemorrhage) [1,10] and also in the absence of parenchymal damage prognosis appears to be good [13]. Various treatment options have been tried in PIVH with minimal success like direct or indirect cerebral revascularization surgery, external ventricular drainage or ventriculo-peritoneal shunt and recently intraventricular infusion of thrombolytic agents.…”