title: Vaginal Delivery under Epidural Analgesia in Pregnant Women with a Diagnosis of Moyamoya Disease.
abstract: BACKGROUND
  Moyamoya disease more commonly occurs in young people and women, so patients with this disease may experience pregnancy and delivery. Cesarean section (CS) is often chosen as the mode of delivery for these patients in Japan. No appropriate mode of delivery has yet been established for pregnant women with moyamoya disease in terms of stroke prevention. We have used vaginal delivery under epidural analgesia (EA) in such patients unless CS has been indicated for the maternal or fetal reasons. This study retrospectively analyzed our patients with moyamoya disease who gave birth to confirm the safety of vaginal delivery under EA.
  
  
  METHODS
  Twelve consecutive patients diagnosed with moyamoya disease had 14 deliveries at our hospital between September 2004 and January 2013. The incidences of intrapartum stroke were compared between cases of vaginal delivery under EA and CS cases.
  
  
  RESULTS
  Ten vaginal deliveries under EA and 4 elective CSs were performed. No intrapartum stroke was observed during either vaginal delivery under EA or CS. Among the patients who underwent vaginal delivery under EA, 1 parturient who experienced 2 deliveries suffered transient ischemic attack during both postpartum periods. All 14 infants were healthy without sequelae.
  
  
  CONCLUSIONS
  Vaginal delivery under EA is an option for patients with moyamoya disease, provided that close cooperation with neurosurgeons, obstetricians, and anesthesiologists is assured.
authors: Department of Neurosurgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan. Electronic address: kimitoshi@k8.dion.ne.jp.
authors: Kimitoshi
authors: K
authors: Sato
authors: Department of Neurosurgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan.
authors: Masaru
authors: M
authors: Yamada
authors: Department of Anesthesiology, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan.
authors: Toshiyuki
authors: T
authors: Okutomi
authors: Division of Anesthesiology & Reanimatology for Paturients/Fetuses/Infants Research & Development Center for New Medical Frontiers, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan.
authors: Rie
authors: R
authors: Kato
authors: Department of Obstetrics, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan.
authors: Nobuya
authors: N
authors: Unno
authors: Department of Neurosurgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan.
authors: Kiyotaka
authors: K
authors: Fujii
authors: Department of Neurosurgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan.
authors: Toshihiro
authors: T
authors: Kumabe
mesh_terms: D000328:Adult; D015360:Analgesia, Epidural / Q000009:adverse effects; D002585:Cesarean Section; D036861:Delivery, Obstetric / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D009072:Moyamoya Disease / Q000150:complications / Q000601:surgery*; D011247:Pregnancy; D012189:Retrospective Studies; D020521:Stroke / Q000209:etiology*
keywords: Analgesia; cesarean section; delivery; moyamoya; stroke; vaginal delivery