Anaesthetic Management of Obstetric Patients with Chiari 1 Malformation with or without Syringomyelia
A group of specialist doctors, including anaesthetists, obstetricians, and neurosurgeons from across the UK, came together to review all the available medical evidence on this topic. Their aim was to find out what the research actually showed about the safety of different pain relief and anaesthetic options for pregnant women with Chiari malformationAn anatomical abnormality affecting the lowermost part of brain, where it joins the spinal cord, at the top of the neck. Various sub-types are described – see under their individual names. The term hindbrain hernia is sometimes used to incorporate all forms., with or without syringomyeliaA cavity, within the spinal cord, which is filled with cerebrospinal fluid. Syringomyelia cavities come in various “shapes and sizes”, from short, spindle-shaped cavities through to long, tense cavities extending throughout the greater part of the spinal cord. See also hydromyelia. More.
Before this work was done, there were no official guidelines anywhere in the world on how to manage these women’s anaesthetic care — meaning that decisions were being made inconsistently, and often based on theoretical concerns rather than real evidence.
The review found that, for women whose Chiari malformationAn anatomical abnormality affecting the lowermost part of brain, where it joins the spinal cord, at the top of the neck. Various sub-types are described – see under their individual names. The term hindbrain hernia is sometimes used to incorporate all forms. or syringomyeliaA cavity, within the spinal cord, which is filled with cerebrospinal fluid. Syringomyelia cavities come in various “shapes and sizes”, from short, spindle-shaped cavities through to long, tense cavities extending throughout the greater part of the spinal cord. See also hydromyelia. More is causing no symptoms or only stable and mild symptoms, the evidence is reassuring. Epidural pain relief in labour — the most effective form of pain relief available — is safe and should not be routinely denied. The same applies to spinal anaesthesia for caesarean birth. No cases of serious neurological harm caused by these techniques have been reported in the published medical literature for women in this group. The mode of birth — whether vaginal or by caesarean section — should be decided based on obstetric reasons and what the woman herself wants, not based on her Chiari or syringomyeliaA cavity, within the spinal cord, which is filled with cerebrospinal fluid. Syringomyelia cavities come in various “shapes and sizes”, from short, spindle-shaped cavities through to long, tense cavities extending throughout the greater part of the spinal cord. See also hydromyelia. More diagnosis alone.
The group also found that most women with Chiari malformationAn anatomical abnormality affecting the lowermost part of brain, where it joins the spinal cord, at the top of the neck. Various sub-types are described – see under their individual names. The term hindbrain hernia is sometimes used to incorporate all forms. or syringomyeliaA cavity, within the spinal cord, which is filled with cerebrospinal fluid. Syringomyelia cavities come in various “shapes and sizes”, from short, spindle-shaped cavities through to long, tense cavities extending throughout the greater part of the spinal cord. See also hydromyelia. More do not need to be referred to a neurosurgeon during pregnancy, nor do they need extra brain or spine scans unless their symptoms change or worsen. What they do need is a planned conversation with both an obstetrician and an anaesthetist during pregnancy, so that their care is thought through in advance and they are informed and supported going into labour and birth.
These findings have been endorsed by multiple medical organisations in the UK, including the Ann Conroy Trust. The overall message is a positive one: with careful assessment and the right planning, most women with Chiari malformationAn anatomical abnormality affecting the lowermost part of brain, where it joins the spinal cord, at the top of the neck. Various sub-types are described – see under their individual names. The term hindbrain hernia is sometimes used to incorporate all forms. or syringomyeliaA cavity, within the spinal cord, which is filled with cerebrospinal fluid. Syringomyelia cavities come in various “shapes and sizes”, from short, spindle-shaped cavities through to long, tense cavities extending throughout the greater part of the spinal cord. See also hydromyelia. More can expect the same pain relief options and the same birth choices as any other woman — and they should feel empowered to ask for them.
The full reasons for the study being carried out, and its findings, have now been published in the medical literature, as a consensus statement. This is available as open access using the link below, as a PDF download or via the QR code.
