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112 Neurofibromatosis type 1 and neuroaxial techniques for labour and delivery. Are they always feasible and safe? Last five year experience in a tertiary centre
  1. VE Vega Sanchez,
  2. E Monge and
  3. C Corbella
  1. Gregorio Marañon University Hospital, Madrid, Spain


Background and Aims Neurofibromatosis type (NF) 1 is an uncommon disease. Up to 9% of asymptomatic patients may have spinal tumours with potential enlargement during pregnancy1. Its unintentional puncture can lead to bleeding and increased intracranial pressure. Brain tumours are described; scoliosis and preeclampsia are more frequent2.

Therefore, the choice of the anaesthetic technique will be guided by risk/benefit ratio, being advisable recent neuroimaging. If any doubt, analgesia with opioids is an option or general anaesthesia if required.

Methods Gregorio Marañón University Hospital (Madrid, Spain) database was searched to identify obstetric patients with history of NF I between January 2016 and June 2021.

Results Two cases and three pregnancies were found:

A 25-yr-old at term was attended at two labours. She had no history of neuroaxial involvement throughout time; first eutocic delivery was done under uneventful epidural anaesthesia (neuroimaging available); 2 years later required episiotomy under local anaesthesia (patient´s choice).

A 39-yr-old patient with peripheral neurofibromas history and no neurological follow-up required analgesia for labor, remifentanil institutional PCA protocol was offered; but labour induction failed and c-section was done under general anaesthesia.

Conclusions Patients with NF-1 are a challenge to the obstetric anaesthesiologist and may complicate the management of labour analgesia. Neuroaxial techniques are not precluded but to be safely performed a case by case assessment and recent neuroimaging (brain and neuroaxial) are advisable, especially if the patient develops any neurological symptoms.

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