Anesthetic Management of Labor & Delivery in Patients with Elevated 

 

 

• Elevated ICP during pregnancy is rare but associated with significant maternal and fetal risk

• Physiologic changes of pregnancy may exacerbate intracranial hypertension, with risk greatest during labor and deliver 

• Evidence guiding anesthetic management in the obstetric population is limited with management based on pathophysiology and extrapolated largely from neuroanesthesia literature

• Preservation of cerebral perfusion pressure and prevention of secondary brain injury are central anesthetic goals

   

  Case Presentation

  • 29-year-old G1P0 at 32 weeks presented with seizures

  • History of ankylosing spondylitis, on humira with a known thoracic mass 

  • Subacute headache worsening over several weeks with seizure-like episode, AMS, and elevated ICP

  • Lumbar Puncture: Opening pressure >55 cm H₂O, ↑ protein and glucose

  • EVD placed with return to baseline neurological status  

  • C-section at 34 weeks under GETA

  • EVD open throughout case, patient tolerated very wel

  • Steroid course completed and VP shunt placed on POD #12without complication 

  • Currently- stable on Humira and off steroids 6 months

 

 

• Neuraxial Anesthesia Considerations

• Risk of herniation with dural puncture

• Avoid with mass effect or CSF obstruction

 

• General Anesthesia

• Blunt laryngoscopy response

• Avoid hypercarbia, hypoxia, instability

 

• ICP Management Strategies

• CSF diversion (EVD)

• Head elevation, controlled ventilation

 

 

• Multidisciplinary coordination essential

• Maternal stability determines fetal outcome