Turkish Neurosurgery
Effect of Pregnancy in Ventriculoperitoneal Shunt Survival and Prognosis: A Systematic Review and Meta-Analysis
Tariq Al-Saadi1, Marija Glisic3, Ali Al Sharqi2, Safiya Al Kharusi2, Malik Al Shaqsi2, Noor Al Jabri2, Jawahir Al Sharqi2
1Montreal Neurological Institute , Neurosurgery, Montreal/QC,
2Sultan Qaboos University Hospital , Neurosurgery, Muscat,
3Leibniz Institute for Prevention Research and Epidemiology, Epidemiology, Deutschland,
DOI: 10.5137/1019-5149.JTN.27581-19.4

Abstract: Objective: To study the effect of pregnancy in ventriculoperitoneal (VP) shunt survival and prognosis in shunt dependent women. Methods: Three electronic databases MEDLINE (PubMed), EMBASE and the Cochrane Library were systematically searched to identify studies published in English between 1950 and 2019. We additionally searched Web of Science, Google Scholar and ClinicalTrials.gov. Case reports and case series reporting on pregnancy complications in women with VP shunt were included. Results: Among the 38 cases of pregnant VP shunt dependent women, median age was 25.5 years and shunting duration was 15.5 years with 11 women being shunted at birth or soon after. Congenital diseases were the most common reason for shunting, present in 63.2% of women. The antepartum complications were reported in 19 (50%) of cases with the symptoms of increased ICP being the most commonly reported (73.7%). In the majority of cases the complications were resolved with shunt reservoir tapping (26.3%). Eight women (42.1%) had spontaneous vaginal delivery. In 7 women, postpartum antibiotic prophylaxis was initiated. All newborns, besides a single one, were born healthy or with no complications. There was one fetal demise occurred in a woman that was diagnosed with tuberous sclerosis. Conclusion: Based on our findings VP shunt appears not to be a contraindication for pregnancy. Pumping of the shunt is an effective method of relieving the symptoms of a malfunctioning and the routine use of prophylactic antibiotics to prevent shunt infection is not recommended. Vaginal delivery should be attempted unless a cesarean section is inevitably required.

Corresponding author : Tariq Al-Saadi