Cerebrospinal fluid shunting and pregnancy

The aim of this study is to survey the literature and update the steps to be taken in managing a pregnant patient in whom cerebrospinal fluid (CSF) shunting has been performed. The risk of valve malfunction (VMF) during pregnancy is approximately 27.5% and is mainly produced by a functional obstruction due to an increase in intra abdominal pressure during gestation. The risk of VMF and complications rises until 6 months after childbirth. The study of the functioning of the shunt and genetic counselling prior to conception are of vital importance. We discuss the steps to be taken during pregnancy, and during and after childbirth, as well as the implications of CSF shunting in a pregnant patient from a neurological, neurosurgical, obstetric and anaesthetic point of view. Although maternal progress is excellent (100% were asymptomatic 6 months after childbirth), there is also a very high percentage of miscarriages (24%) of unknown causation. Prospective studies are needed to explain different conflicting points in the series currently available.