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もやもや病罹患女性の妊娠・分娩に関して,全国産科施設と患者女性に対する調査を行った.本症既知例では周産期の重篤な脳血管イベント発生率は低く抑えられていた.帝王切開での管理が現在の主流であるが,経膣分娩,特に硬膜外麻酔による無痛分娩の適応拡大の可能性が示唆された.一方,本症罹患を知らずに妊娠した場合に重篤な周産期脳血管イベントが発生しており,脳出血が予後不良の主原因であった.今回の実態調査を踏まえ,産科医と脳神経外科医が協力して,もやもや病合併妊娠・分娩の管理指針を確立する必要がある.
The authors conducted a nationwide survey of women with moyamoya disease on their pregnancy and delivery experiences. In pregnant women who were known to have moyamoya disease, the incidence of perinatal cerebrovascular attacks was low. Although caesarian section was mainly adopted in these cases, there was no evidence that vaginal delivery should be avoided. On the other hand, serious cerebral hemorrhage or infarction was reported in those patients who had not been diagnosed with moyamoya disease before their pregnancy. To make pregnancy and delivery of the female patients safer, cooperation between obstetrician and neurosurgeons is important, and guidelines on pregnancy management for female patients with moyamoya disease should be established.
