Safety of Sacral Nerve Stimulation in Pregnancy: A Literature Review.
OBJECTIVE
Sacral nerve stimulation (SNS) is an FDA approved intervention for a spectrum of conditions. Women of childbearing age and those who are pregnant constitute a fair number of sufferers of overactive bladder symptoms and nonobstructive urinary retention; however, hypothesized effects of SNS on the fetus, mother, and the device limit its use in such a group of patients. We present a literature review to support possible safety of SNS in pregnancy.


METHODS
We reviewed a number of animal studies on effects of neuromodulation on myometrial activity and fetal abnormalities, and several case reports and series describing continued SNS as well as other related modes of neuromodulation during gestation and reported effects on the mother, fetus, and device.


RESULTS
Studies on female mammals showed neurostimulation of myometrial tissue aided in embryo transfer and increased latency, evidence against inducing preterm labor, and follow-up of pregnant rats showed no effects on mothers or offspring. Reviewed cases adopted interrupted and uninterrupted courses of SNS until delivery. There were almost no pregnancy complications; infants were healthy at birth, delivered electively by Caesarean section close to term. One follow-up of 2 infants reported some health issues, though SNS was not concluded as a cause. Device replacement after delivery was occasionally performed for different reasons.


CONCLUSIONS
No negative effects of SNS on fetus, mother or device were significantly reported in literature. Further studies expanding on data in the literature could place SNS therapy during pregnancy on the way for declaration as a safe practice.
Ministry of Health, Al Amiri Hospital, Kuwait City, Kuwait. syaiesh@hotmail.com.
Said M
SM
Yaiesh
Ministry of Health, Al Amiri Hospital, Kuwait City, Kuwait.
Abdullatif E
AE
Al-Terki
Ministry of Health, Al Amiri Hospital, Kuwait City, Kuwait.
Tariq F
TF
Al-Shaiji
D000818:Animals; D016206:Databases, Bibliographic / Q000706:statistics & numerical data; D004599:Electric Stimulation Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D011247:Pregnancy; D011248:Pregnancy Complications / Q000503:physiopathology / Q000628:therapy*; D051381:Rats; D013127:Spinal Nerves / Q000502:physiology*
Bladder dysfunction; neuromodulation; neurostimulation; pregnancy; review article; sacral nerve stimulation