Акушерство и Гинекология Санкт-Петербурга. 2018; : 23-29
Особенности ведения беременности и родов у женщин с патологией центральной нервной системы
Аннотация
В последние годы прослеживается тенденция к увеличению количества беременных с экстрагенитальной патологией, среди них особое место занимают заболевания центральной нервной системы, которые представляют высокий риск возникновения осложнений течения беременности и родов, угрозу для жизни беременной и плода. В исследование включены 466 женщин. Оно носило ретроспективный когортный характер и заключалось в анализе методов обследования, лечения, наличия осложнений и способов родоразрешения. До настоящего времени нет единого подхода к методам обследования данной категории женщин. Разработка новых методов диагностики и лечения заболеваний ЦНС у беременных позволит повысить эффективность оказания медицинской помощи и будет способствовать реализации репродуктивных возможностей у таких пациенток. Требуется разработка тактики по прегравидарной подготовке, ведению беременности, определению способов родоразрешения, ведению послеродового периода с оценкой отдаленных последствий совместно с акушером-гинекологом, неврологом, нейрохирургом, эпилептологом, психотерапевтом, реабилитологом.
Список литературы
1. АрустамянР.Р.,Ляшко Е.С., ШифманЕ.М., Конышева О.В., ВорыхаевА.В. Разрыв артериовенозной мальформации во время беременности и в послеродовом периоде. Российский медицинский журнал. 2014; 1: 85-87.
2. Васильев Ю.Д., Сидельникова Л.В, Арустамян Р.Р. Диагностика острых нарушений мозгового кровообращения у беременных, родильниц и рожениц. Проблемы репродукции. 2016; (4): 111-114. doi: 10.17116/re-pro2016224111-114.
3. Гусев Е. И., Скворцова В. И., Ст аховская Л. В. Эпидемиология и нсул ьта в России. В кн.: Доказательная медицина. Ежегодный справочник. Вып. 1. М.: Медиа Сфера, 2002.
4. Дмитренко Д.В., Шнайдер Н.А., Егорова А.Т. и др. Эпилепсия и беременность: монография. - М.: Медика, 2014.
5. Лихтерман Л.Б. Черепно-мозговая травма. Диагностика и лечение. М.: ГЭОТАР-Медиа, 2014.
6. Agarwal N., Guerra J.C., Gala N.B., Karimi R.J., Turbin R.E., Gandhi C.D. et al. Current treatment options for cerebral arteriovenous malformations in pregnancy: a review of the literature. World Neurosurg. 2014; 81 (1): 83-90.
7. Alluwimi I., Rahman Al-AnaziA. Meningioma in Pregnancy. Bahrain Medical Bulletin. 2004; 26 (2): 1-9.
8. Bateman B.T., Schumacher H.C., Bushnell C.D., Pile-Spellman J., Simpson L.L., Sacco R.L. et al. Intracerebral hemorrhage in pregnancy: frequency, risk factors, and outcome. Neurology. 2006; 67 (3): 424-429.
9. Battino D., Tomson T., Bonizzoni E. et al. EURAP Study Group. Seizure control and treatment changes in pregnancy: observations from the EURAP epilepsy pregnancy registry. Epilepsia. 2013; 54 (9): 1621-7. doi: 10.1111/epi.12302.
10. BealC.C., FaucherM.A. Stroke and pregnancy: an integrative review with implications for neuroscience nurses. J Neurosci Nurs. 2015 Apr; 47 (2): 76-84. doi: 10.1097/JNN.0000000000000119.
11. Borthen I., EideM.G., DaltveitA.K., GilhusN.E. Obstetric outcome in women with epilepsy: a hospital-based, retrospective study. BJOG. 2011; 118 (8): 956-965. doi: 10.1111/j.1471-0528.2011.03004.x.
12. DaviesJ.M., Kim H., Lawton M.T. Surgical treatment of cerebral cavernous malformations. J Neurosurg Sci. 2015; 17: 25.
13. Ebner F.H., Bornemann A., Wilhelm H. et al. Tuberculum sellae meningioma symptomatic during pregnancy: pathophysiological considerations. Acta Neurochir. (Wien). 2008; 150 (2): 189-193.
14. Gross B.A., Du R. Haemorrhage from arteriovenous malformations during pregnancy. Neurosurgery. 2012; 71 (2): 349-356.
15. Hatiboglu M.A., Cosar M., Iplikcioglu A.C. Sex steroid and epidermal growth factor profile of giant meningiomas associated with pregnancy. Surg. Neurol. 2008; 69 (4): 356-362.
16. Kalani MX, Zabramski J.M. Risk for symptomatic haemorrhage of cerebral cavernous malformations during pregnancy. J Neurosurg. 2013; 118 (1): 5055.
17. Kanaan I., Jallu A., Kanaan H. Management Strategy for Meningioma in Pregnancy: A Clinical Study. Skull Base. 2003; 13 (4): 197-203.
18. Kim Y.W., Neal D., Hoh B.L. Cerebral aneurysms in pregnancy and delivery: pregnancy and delivery do not increase the risk of aneurysm rupture. Neurosurgery. 2013; 72 (2): 143-149. doi: 10.1227/NEU.0b013e3182796af9.
19. Kolias A. G., Guilfoyle M. R., Helmy A., Allanson J. et al. Traumatic brain injury in adults. Pract. Neurol. 2013; 13 (4): 228-235.
20. Kurdoglu Z., Cetin O., Gulsen I., Drink D., Bulut M.D. Intracranial Meningioma Diagnosed during Pregnancy Maternal Death. Case Rep Med. 2014: 158326. doi: 10.1155/2014/158326.
21. Lu Ban, Sprigg N., Sultan A., Nelson-Piercy C., Bath P., Ludvigsson J. et al. Incidence of First Stroke in Pregnant and Nonpregnant Women of Childbearing Age: A Population-Based Cohort Study From England. J Am Heart Assoc. 2017; 21: 6 (4). doi: 10.1161/JAHA.116.004601.
22. Lynch J.C., Emmerich J.C., Kislanov S. et al. Brain tumors and pregnancy. Arq. Neuropsiquiatr. 200; 65 (4B): 1211-1215.
23. Pilo C., Wide K., Winbladh B. Pregnancy, delivery, and neonatal complications after treatment with antiepileptic drugs. Acta Obstet Gynecol Scand. 2006; 85 (6): 643-6. doi: 10.1080/00016340600604625.
24. Reisinger T.L., Newman M., Loring D.W. et al. Antiepileptic drug clearance and seizure frequency during pregnancy in women with epilepsy. Epilepsy Be-hav. 2013; 29 (1): 13-18. doi: 10.1016/j.yebeh.2013.06.026.
25. TateJ., BushnellC. Pregnancy and stroke risk in women. Womens Health (Lond Engl). 2011; 7 (3): 363-74. doi: 10.2217/whe.11.19.
26. TreadwellS.D., Thanvi B., Robinson T.G. Stroke in pregnancy and the puerperi-um. Postgrad Med J. 2008; 84 (991): 238-245. doi: 10.1136/pgmj.2007.066167.
Obstetrics and Gynaecology of Saint-Petersburg. 2018; : 23-29
Features of pregnancy and childbirth in women with pathology of the central nervous system
Abstract
In recent years, there has been a trend towards an increase in the number of pregnant women with extragenital pathology, among them a special place is occupied by diseases of the central nervous system that pose a high risk of complications of pregnancy and childbirth, a threat to the life of the pregnant woman and the fetus. The study included 466 women who had a retrospective cohort character and consisted in the analysis of methods of examination, treatment, the presence of complications and methods of delivery. Until now, there is no single approach to the methods of examining this category of women. The development of new methods for diagnosis and treatment of CNS diseases in pregnant women will increase the effectiveness of medical care and will promote the realization of reproductive opportunities in such patients. It requires the development of tactics for pregravid preparation, management of pregnancy, determination of methods of delivery, management of the postpartum period with evaluation of long-term consequences together with an obstetrician-gynecologist, neurologist, neurosurgeon, epileptologist, psychotherapist, rehabilitologist.
References
1. ArustamyanR.R.,Lyashko E.S., ShifmanE.M., Konysheva O.V., VorykhaevA.V. Razryv arteriovenoznoi mal'formatsii vo vremya beremennosti i v poslerodovom periode. Rossiiskii meditsinskii zhurnal. 2014; 1: 85-87.
2. Vasil'ev Yu.D., Sidel'nikova L.V, Arustamyan R.R. Diagnostika ostrykh narushenii mozgovogo krovoobrashcheniya u beremennykh, rodil'nits i rozhenits. Problemy reproduktsii. 2016; (4): 111-114. doi: 10.17116/re-pro2016224111-114.
3. Gusev E. I., Skvortsova V. I., St akhovskaya L. V. Epidemiologiya i nsul 'ta v Rossii. V kn.: Dokazatel'naya meditsina. Ezhegodnyi spravochnik. Vyp. 1. M.: Media Sfera, 2002.
4. Dmitrenko D.V., Shnaider N.A., Egorova A.T. i dr. Epilepsiya i beremennost': monografiya. - M.: Medika, 2014.
5. Likhterman L.B. Cherepno-mozgovaya travma. Diagnostika i lechenie. M.: GEOTAR-Media, 2014.
6. Agarwal N., Guerra J.C., Gala N.B., Karimi R.J., Turbin R.E., Gandhi C.D. et al. Current treatment options for cerebral arteriovenous malformations in pregnancy: a review of the literature. World Neurosurg. 2014; 81 (1): 83-90.
7. Alluwimi I., Rahman Al-AnaziA. Meningioma in Pregnancy. Bahrain Medical Bulletin. 2004; 26 (2): 1-9.
8. Bateman B.T., Schumacher H.C., Bushnell C.D., Pile-Spellman J., Simpson L.L., Sacco R.L. et al. Intracerebral hemorrhage in pregnancy: frequency, risk factors, and outcome. Neurology. 2006; 67 (3): 424-429.
9. Battino D., Tomson T., Bonizzoni E. et al. EURAP Study Group. Seizure control and treatment changes in pregnancy: observations from the EURAP epilepsy pregnancy registry. Epilepsia. 2013; 54 (9): 1621-7. doi: 10.1111/epi.12302.
10. BealC.C., FaucherM.A. Stroke and pregnancy: an integrative review with implications for neuroscience nurses. J Neurosci Nurs. 2015 Apr; 47 (2): 76-84. doi: 10.1097/JNN.0000000000000119.
11. Borthen I., EideM.G., DaltveitA.K., GilhusN.E. Obstetric outcome in women with epilepsy: a hospital-based, retrospective study. BJOG. 2011; 118 (8): 956-965. doi: 10.1111/j.1471-0528.2011.03004.x.
12. DaviesJ.M., Kim H., Lawton M.T. Surgical treatment of cerebral cavernous malformations. J Neurosurg Sci. 2015; 17: 25.
13. Ebner F.H., Bornemann A., Wilhelm H. et al. Tuberculum sellae meningioma symptomatic during pregnancy: pathophysiological considerations. Acta Neurochir. (Wien). 2008; 150 (2): 189-193.
14. Gross B.A., Du R. Haemorrhage from arteriovenous malformations during pregnancy. Neurosurgery. 2012; 71 (2): 349-356.
15. Hatiboglu M.A., Cosar M., Iplikcioglu A.C. Sex steroid and epidermal growth factor profile of giant meningiomas associated with pregnancy. Surg. Neurol. 2008; 69 (4): 356-362.
16. Kalani MX, Zabramski J.M. Risk for symptomatic haemorrhage of cerebral cavernous malformations during pregnancy. J Neurosurg. 2013; 118 (1): 5055.
17. Kanaan I., Jallu A., Kanaan H. Management Strategy for Meningioma in Pregnancy: A Clinical Study. Skull Base. 2003; 13 (4): 197-203.
18. Kim Y.W., Neal D., Hoh B.L. Cerebral aneurysms in pregnancy and delivery: pregnancy and delivery do not increase the risk of aneurysm rupture. Neurosurgery. 2013; 72 (2): 143-149. doi: 10.1227/NEU.0b013e3182796af9.
19. Kolias A. G., Guilfoyle M. R., Helmy A., Allanson J. et al. Traumatic brain injury in adults. Pract. Neurol. 2013; 13 (4): 228-235.
20. Kurdoglu Z., Cetin O., Gulsen I., Drink D., Bulut M.D. Intracranial Meningioma Diagnosed during Pregnancy Maternal Death. Case Rep Med. 2014: 158326. doi: 10.1155/2014/158326.
21. Lu Ban, Sprigg N., Sultan A., Nelson-Piercy C., Bath P., Ludvigsson J. et al. Incidence of First Stroke in Pregnant and Nonpregnant Women of Childbearing Age: A Population-Based Cohort Study From England. J Am Heart Assoc. 2017; 21: 6 (4). doi: 10.1161/JAHA.116.004601.
22. Lynch J.C., Emmerich J.C., Kislanov S. et al. Brain tumors and pregnancy. Arq. Neuropsiquiatr. 200; 65 (4B): 1211-1215.
23. Pilo C., Wide K., Winbladh B. Pregnancy, delivery, and neonatal complications after treatment with antiepileptic drugs. Acta Obstet Gynecol Scand. 2006; 85 (6): 643-6. doi: 10.1080/00016340600604625.
24. Reisinger T.L., Newman M., Loring D.W. et al. Antiepileptic drug clearance and seizure frequency during pregnancy in women with epilepsy. Epilepsy Be-hav. 2013; 29 (1): 13-18. doi: 10.1016/j.yebeh.2013.06.026.
25. TateJ., BushnellC. Pregnancy and stroke risk in women. Womens Health (Lond Engl). 2011; 7 (3): 363-74. doi: 10.2217/whe.11.19.
26. TreadwellS.D., Thanvi B., Robinson T.G. Stroke in pregnancy and the puerperi-um. Postgrad Med J. 2008; 84 (991): 238-245. doi: 10.1136/pgmj.2007.066167.
