title: Pregnancy and vaginal delivery in epidural analgesia in woman with cerebrospinal fluid shunt.
abstract: Hydrocephalus is a medical condition characterized by enlargement of cerebral ventricles due to abnormal cerebrospinal fluid accumulation. Hydrocephalic women with cerebrospinal fluid (CSF) shunts are now surviving to reproductive age, but still there are doubts regarding the mode of delivery, analgesia and anesthesia. Postpartal complications are more frequently described in deliveries ended by cesarean section than in spontaneous vaginal deliveries. We present a case of labor in the 32-year old woman, with congenital hydrocephalus and a preexisting ventriculoperitoneal (VP) shunt. After thorough review of current literature, we came to conclusion that without absolute neurosurgical indication or acute development of listed symptoms (headaches, irritability, light sensitivity, hyperesthesia nausea, vomiting, vertigo, migraines, seizures, weakness in the arms or legs, strabismus and double vision) the best way to finish the pregnancy of woman with VP shunt is spontaneous vaginal delivery with the use of epidural analgesia, mediolateral episiotomy and vacuum extraction.
authors.affiliation: University of Zagreb, University Hospital Merkur, Clinical Department of Obstetrics and Gynecology, Zagreb, Croatia.
authors.forename: Danijel
authors.initials: D
authors.lastname: Bursac
authors.affiliation: University of Zagreb, University Hospital Merkur, Clinical Department of Obstetrics and Gynecology, Zagreb, Croatia.
authors.forename: Tomislav
authors.initials: T
authors.lastname: Kulas
authors.affiliation: University of Zagreb, University Hospital Dubrava, Clinical Department of Anesthesiology, Resuscitation and Intensive Care Medicine, Zagreb, Croatia.
authors.forename: Jasminka
authors.initials: J
authors.lastname: Persec
authors.affiliation: University of Zagreb, University Hospital Dubrava, Department of Urology, Zagreb, Croatia.
authors.forename: Zoran
authors.initials: Z
authors.lastname: Persec
authors.affiliation: University of Zagreb, University Hospital Merkur, Clinical Department of Obstetrics and Gynecology, Zagreb, Croatia.
authors.forename: Zeljko
authors.initials: Z
authors.lastname: Duić
authors.affiliation: University of Zagreb, University Hospital Merkur, Clinical Department of Obstetrics and Gynecology, Zagreb, Croatia.
authors.forename: Jasenka Zmijanac
authors.initials: JZ
authors.lastname: Partl
authors.affiliation: General Hospital Pozega, Department of Surgery, Pozega, Croatia.
authors.forename: Zeljko
authors.initials: Z
authors.lastname: Glavić
authors.affiliation: General Hospital Offenbach, Department of Obstetrics and Gynecology, Offenbach am Main, Germany.
authors.forename: Zlatko
authors.initials: Z
authors.lastname: Hrgović
authors.affiliation: University of Zagreb, University Hospital Merkur, Department of Neonatology, Zagreb, Croatia.
authors.forename: Katarina
authors.initials: K
authors.lastname: Bojanić
mesh_terms: D000328:Adult; D015360:Analgesia, Epidural; D002557:Cerebrospinal Fluid Shunts; D036861:Delivery, Obstetric; D005260:Female; D006801:Humans; D011247:Pregnancy