Pregnancy and labour in women with spina bifida
Authors: Reinhold Cremer[1], Nils Hofmann[1], Friedrich Wolff[2]
Background
In general fertility is not reduced in women with spina bifida
and hormonal contraception is more difficult to perform due to an
increased risk of thrombosis in paraplegia. Thus pregnancies of
women with spina bifida are possible. There is a lack of larger
cohorts in the literature to manage pregnancy and birth evidence
based.
Materials and Methods
We present five pregnancies in four women out of 180 patients of
our spina bifida outpatient clinic.
Results
Only one of five pregnancies was terminated preterm, none of the
five fetuses had a neural tube defect (only in 3 pregnancies
appropriate folate prophylaxis) had been given (no father had a
neural tube defect). The two mothers with a shunted hydrocephalus
had no complications of their shunting devices during pregnancy and
labour. Urinary tract infections were a major problem only in one
woman, who also had a single kidney and severe urinary tract
infections before pregnancy. Intermittent catheterisation was
performed by three women during their pregnancies without
complications. None of the women needed antihypertensive drugs
during pregnancy.
All full term newborns were born by Caesarean section and had no
peripartual problems. Care for the infants after birth was given by
the father (in two children) or by help of the grandparents.
Conclusions
Before planning to get pregnant a genetic counselling should
inform about the recurrence risk for neural tube defects (about
four percent). A folate prophylaxis is not taken regularly even in
this high risk group. The rate of abortions in pregnancies of
mothers with spina bifida is not well documented in the literature
due to a lack of larger cohorts. In our cohort the low rate of
urological and shunt-related complications is remarkable. During
pregnancy and labour a very individual care of the pregnant women
has to be established due to the complexity of problems (different
mobility, the presence of a CSF shunting valve, urological
situation with neurogenic bladder and different methods for bladder
emptying). Pregnancy and labour as well as postnatal care of the
infant are new tasks for spina bifida outpatient clinics. New
co-operations with obstetrical departments have to be established,
to solve the demanding medical and social problems together.
[1]Paediatric Clinic,
[2]Gynaecological Clinic
Amsterdamer Str. 59, 50735 Cologne, Germany
Email: CremerR@kliniken-koeln.de
