Obstetric Management and Maternal Outcomes of Childbirth among Patients with Chiari Malformation Type i

D. Andrew Wilkinson, Kyle Johnson, Peris R. Castaneda, Jeffrey L. Nadel, Hugh J.L. Garton, Karin M. Muraszko, Cormac O. Maher

Research output: Contribution to journalArticlepeer-review

4 Scopus citations

Abstract

BACKGROUND: A range of opinions exist in the literature regarding obstetric management of pregnant women with Chiari malformation type I (CM-I). OBJECTIVE: To examine obstetrical practices and outcomes with childbirth of women with CM-I. METHODS: We examined insurance claims data from a large, privately insured health care network and identified admissions for childbirth from 2004 to 2014. Women with a diagnosis of CM-I as well as normal controls were analyzed for demographic characteristics, type of obstetric management, and complications of childbirth. RESULTS: We identified 866 patients with CM-I diagnosis who had 1048 hospitalizations for delivery, including 103 deliveries to 83 patients who underwent performance of CM-I decompression (CMD) either before or after childbirth. Among 400 births that occurred after CM-I diagnosis, rates of caesarean section (C-section) were higher (42.3% vs 36.2%, OR 1.29, 95% CI 1.00-1.66, P =. 05) and rates of epidural analgesia were lower (45.3% vs 55.4%, OR 0.67, 95% CI 0.52-0.85, P =. 001) compared to 648 births before CM-I diagnosis. The rate of serious maternal morbidity was similar among deliveries to women with CM-I diagnosis (both before and after delivery) compared to 11 000 normal controls. CONCLUSION: A diagnosis of CM-I prior to delivery is associated with a higher rate of C-section and a lower rate of epidural analgesia. Rates of serious maternal morbidity among women with CM-I were similar to those for normal controls. The data suggest a predelivery diagnosis of CM-I may influence obstetric decisions despite no evidence of substantially increased delivery risk in this group.

Original languageEnglish (US)
Pages (from-to)45-52
Number of pages8
JournalNeurosurgery
Volume87
Issue number1
DOIs
StatePublished - Jul 1 2020

All Science Journal Classification (ASJC) codes

  • Surgery
  • Clinical Neurology

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