Chiari and Pregnancy

CHIARI AND PREGNANCY (BY TCI)
"Not all Chiarians are created equal. It is important to see a specialist in the field to properly evaluate how to deliver if you have Chiari Malformation/ Syringomyelia. The presence of SM may require C-section rather than vaginal delivery.

Patients with Posterior Fossa Decompression who are pregnant: Patients with successful decompression or very minimal Chiari symptoms have less risk when an epidural is part of the plan. If prolonged labor occurs this can put more pressure on the central nervous system (brain and spinal column) and the option for a C-section should be considered. If you have had a successful decompression a vaginal delivery should be considered. Some patients are under-decompressed, so this rule is only true for successful PFD's. In order to know if you are a successful decompression you need an MRI of the brain and some resolution of symptoms.

Patients without a Posterior Fossa Decompression and no SM: They are usually monitored closely. Anepidural can worsen CM/SM if the epidural is performed too deep (goes past the dura). Also a vaginal delivery can make CM worse if you have a syrinx.

Patients with NO decompression and with SM: The size of the syrinx matters. An open MRI is recommended at 35 weeks gestation. If the MRI reveals a larger syrinx or neurological signs are increasing, a C-section is indicated. If one is stable and the syrinx has not changed, you may proceed to the 40th week of pregnancy and be careful with the epidural as stated above.

Of course, if you are disproportioned (the baby is larger than your birth canal) one must go C-section. Usually during pregnancy many patients feel better and some of your symptoms can improve. Every patient is different and on should have an evaluation prior to delivery."