It is controversial if pregnancy is a risk factor for idiopathic intracranial hypertension. Certainly, symptoms may first appear in pregnancy, and women previously diagnosed may become symptomatic. Symptoms usually develop by midpregnancy, tend to be self-limited, and usually resolve postpartum.
Pregnancy does not alter management. Some recommend serial visual field testing to forestall permanent vision loss. In a report of 16 pregnant women, visual ield loss developed in four, and it became permanent in one (Huna-Baron, 2002). Visual ield loss is often coincident with the development of papilledema, for which acetazolamide is given. Lee and associates (2005) reported successful treatment of 12 pregnant women. Although outmoded for treatment of nonpregnant individuals, repeated lumbar punctures are generally successful in providing temporary relief throughout pregnancy. In some pregnant women, surgical therapy becomes necessary, and we and others have had promising results with optic nerve sheath fenestration (hambisetty, 2007).
Pregnancy complications are likely due to associated obesity and not to intracranial hypertension. In a review of 54 pregnancies, rates of adverse perinatal outcomes were not elevated (Katz, 1989). he route of delivery depends on obstetrical indications, and conduction analgesia is safe (Aly, 2007; Karmaniolou, 2011).
Pregnancies in women with previously placed ventricular shunts for obstructive hydrocephalus usually have satisfactory outcomes (Landwehr, 1994). Shunts may be ventriculoperitoneal, ventriculoatrial, or ventriculopleural. Partial obstruction of a shunt is common, especially late in pregnancy (Schiza, 2012). In one report of 17 such pregnancies, neurological complications were reported in 13 (Wisof, 1991). Findings included headaches in 60 percent, nausea and vomiting in 35 percent, lethargy in 30 percent, and ataxia or gaze paresis, each in 20 percent. Most symptoms respond to conservative management. However, if CT scanning during symptom evaluation discloses acute hydrocephaly, then the shunt is tapped or pumped several times daily. In some cases, surgical revision is necessary and may be emergently indicated (Murakami, 2010).
Another shunting procedure is placement of an endoscopic third ventriculostomy for hydrocephalus (de Ribaupierre, 2007). With this, a small hole is created in the loor of the third ventricle to allow CSF to low directly into lower cisterns. One report described successful results in ive pregnant women who underwent endoscopic ventriculostomy (Rifaud, 2006). In a review, however, reproductive function and miscarriage rates were found to significantly worsen in these women (Bedaiwy, 2008).
Vaginal delivery is preferred in women with shunts, and unless there is a meningomyelocele, conduction analgesia is permitted. Antimicrobial prophylaxis is indicated if the peritoneal cavity is entered for cesarean delivery or tubal sterilization.
Brain death is rare in obstetrics. Life-support systems and parenteral alimentation for up to 15 weeks while awaiting delivery have been described (Hussein, 2006; Powner, 2003; Souza, 2006). Some women were treated with aggressive tocolysis and antimicrobial therapy. In one review of 17 women with persistent vegetative state who were given various levels of support, five women died after delivery, and most of the others remained in their vegetative state (Chiossi, 2006).