What is the safest approach to delivery in a pregnant woman with pseudotumor cerebri?

Question

Hi doctor,

I have pseudotumor cerebri and I am six weeks pregnant. I am having my fourth cesarian section. What is a safe way for me to deliver my baby?

Answer 1

Hi,

Welcome to icliniq.com

I have read your query and understand your concern.

Pseudotumor cerebri, also known as idiopathic intracranial hypertension is a condition in which pressure around the brain increases causing headaches and vision problems. It is also known as a false brain tumor as the symptoms are similar to that of a brain tumor. Symptoms include headache and vision issues and sometimes there is even complete loss of sight due to pressure-related swelling of the optic nerve. Research says that weight loss helps with it.

I suggest the following-

1) Have Folic Acid 5 mg daily.

2) Try to have recreational activities.

3) Have an antenatal booking with a maternal medicine consultant.

4) Have strict salt control in your diet and if possible, avoid it.

5) There should be strict blood pressure monitoring at home and if it is higher than normal, report it to your healthcare provider.

6) Go for a daily walk and do not get stressed. Focus on emotional, physical, and mental well-being.

7) IIH (idiopathic intracranial hypertension) in pseudotumor cerebri pregnant patients is managed the same way as a regular pseudotumor cerebri patient in relation to imaging and drugs.

8) Treatment should focus on the preservation of vision and resolution of symptoms.

9) Medical management must be done with a cholesterol-free non-ketogenic diet, serial lumber puncture, diuretics, steroids, and analgesics.

10) If vision loss is not controlled medically then the next option should be surgery.

11) You need to be on continuous, strict, and proper monitoring under a maternal medicine consultant in tertiary care so that you can have all facilities for treatment including emergency.

12) Delivery will need special management in terms of anesthesia and the mode of delivery must be discussed in detail ahead of time.

13) Anesthesia will be either spinal or general anesthesia, and it is recommended to avoid epidural anesthesia to avoid damage to the epidural shunt.

14) Obese patients will have more risks during anesthesia and surgery.

15) It is reported that patients with proper preexisting cerebral spinal fluid shunts and proper management can have a normal delivery. Outlet forceps are advised to prevent a prolonged second stage of labor.

Hope this helps.

Thank you and take care.