Rates of Cesarean Delivery and Neurologic Complications in Parturients With Cerebrospinal Fluid Shunts [ID 2683661

Abstract

INTRODUCTION: The effect of parturition on neurologic status in CSF shunt-dependent patients is poorly understood. Cesarean delivery has been proposed as a safer alternative to labor in this population based on limited case reports and retrospective data in the literature; however, the true risk of vaginal delivery has not been adequately described. To our knowledge, this is the first study to estimate national incidence of neurologic complications based on delivery mode in shunt-dependent parturients. METHODS: The Nationwide Readmissions Database (NRD) was queried for obstetric patients undergoing delivery between 2016 and 2018. ICD-10 codes were used to identify delivery mode, preexisting CSF shunt-dependence, obstetric comorbidities, and neurologic complications. Data were weighted per NRD specifications. RESULTS: Of 11,021,188 total deliveries, 1,856 were in shunt-dependent patients. The primary cesarean rate was 41.2% (n=613) versus 20.1% (n=1,823,517) for shunted and non-shunted parturients, respectively. Multivariate analysis confirmed that presence of a shunt independently predicted cesarean delivery (OR 2.4; CI, 2.0–2.9). Intrapartum shunt complication rates were low regardless of delivery mode (vaginal:0.5%, cesarean:0.5%). Additionally, there was no significant difference in rates of brain herniation (P=.82) or CNS infection (P=.15). CONCLUSION: There is no difference in neurologic complication rates between CSF shunt-dependent patients undergoing cesarean and vaginal delivery; however, cesarean delivery is performed at more than twice the rate of the general population. CSF-shunt dependence alone may not be an independent indication for cesarean delivery in the absence of other obstetric indications.