title: Vaginal delivery in pregnancy with Moyamoya disease: experience at a single institute.
abstract: OBJECTIVE
  Cesarean section is commonly selected in pregnancy with Moyamoya disease. We consider vaginal delivery with epidural anesthesia a viable alternative in such cases.
  
  
  METHODS
  Mode of delivery and outcomes were examined in 27 pregnancies in 19 women with Moyamoya disease treated at the Department of Perinatology, National Cardiovascular Center, Japan, from 1983 to 2013. Of these 27 pregnancies, 20 were delivered vaginally with epidural anesthesia. The cerebral circulation, mode of delivery, maternal outcome (presence of symptoms due to Moyamoya disease intrapartum) and neonatal outcome (gestational week, birthweight, Apgar score at 5 min and pH of umbilical artery) were investigated.
  
  
  RESULTS
  The cerebral circulation was judged to be good in all pregnancies. No symptoms due to Moyamoya disease intrapartum were seen in the vaginal delivery cases.
  
  
  CONCLUSIONS
  Our findings indicate that vaginal delivery is viable in pregnancy with Moyamoya disease and that unnecessary cesarean section may be avoided. These findings are limited by the retrospective nature of the study.
authors.affiliation: Department of Perinatology, National Cerebral and Cardiovascular Center, Osaka, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Tanaka
authors.forename: Shinji
authors.initials: S
authors.lastname: Katsuragi
authors.forename: Kayo
authors.initials: K
authors.lastname: Tanaka
authors.forename: Takekazu
authors.initials: T
authors.lastname: Miyoshi
authors.forename: Chizuko
authors.initials: C
authors.lastname: Kamiya
authors.forename: Naoko
authors.initials: N
authors.lastname: Iwanaga
authors.forename: Reiko
authors.initials: R
authors.lastname: Neki
authors.forename: Jun C
authors.initials: JC
authors.lastname: Takahashi
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Ikeda
authors.forename: Jun
authors.initials: J
authors.lastname: Yoshimatsu
mesh_terms: D000328:Adult; D001034:Apgar Score; D036861:Delivery, Obstetric / Q000379:methods*; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D009072:Moyamoya Disease; D036801:Parturition / Q000502:physiology*; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D055815:Young Adult
keywords: Moyamoya disease; delivery mode; pregnancy