Pregnancy complications in patients with ventriculoperitoneal (VP) shunts

Abstract

Determine obstetrical and shunt-related complications in pregnant patients with a VP shunt. Retrospective cohort study of patients with a VP shunt that delivered at a large hospital system between 1988 and 2022. A clinical research repository was queried, and patients were reviewed if they had (a) billing code for a vaginal or cesarean delivery and (b) free text mention of VP shunt in any note. Prenatal records, discharge summaries, inpatient and outpatient notes were reviewed to identify neurologic and pregnancy complications. Our query flagged 220 patients for review, and 62 met inclusion criteria; others were excluded based on shunt placement following pregnancy or shunt mention due to a fetal anomaly. Among the 62 patients, there were 87 pregnancies delivering 92 infants (Table 1). No patients experienced a VP-shunt malfunction during pregnancy. Eight patients representing 10 pregnancies experienced symptoms concerning for shunt malfunction (e.g. papilledema, headache, abdominal pain, or visual symptoms), however there was no radiographic or shunt tap evidence suggestive of malfunction. Two shunt revisions were identified, both postpartum, and neither patient reported symptoms of shunt malfunction during pregnancy. Obstetrical complications included gestational diabetes (10.3%), preterm delivery (20.7%), and pregnancy-induced hypertension (4.6%). Cesarean section was the most common delivery method (58.6%), 29.4% of which were performed due to the shunt. Currently available case series report up to a 25-50% VP-shunt complication rate in pregnant patients, however they are dated and employ methodologies that may result in reporting bias. Our study includes the largest and most contemporary cohort identified systematically. Our low rate of shunt-related complications and favorable obstetric outcomes provides reassuring information and may be helpful for patient counseling.