A case of spina bifida after ileocystoplasty in a woman who presented with severe hypertensive disorders of pregnancy

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  • 重症妊娠高血圧腎症を発症し妊娠中期に分娩となった二分脊椎膀胱拡大術後妊娠の一例

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Abstract

Pregnancy in a woman with spina bifida (SB) after enterocystoplasty for a neurogenic bladder is rare. However, investigating such cases is important because the number of pregnant women treated for SB will increase with the progression of treatment for SB. We experienced a case of SB after ileocystoplasty in a woman who presented with severe bilateral hydronephrosis and severe hypertensive disorders of pregnancy (HDP) and needed emergency cesarean section (CS) at 29 weeks of gestation. She had undergone spinal cord surgery, anti-reflux operation, and ileocystoplasty for her neurogenic bladder. She became pregnant spontaneously and had an episode of febrile urinary tract infections, which were treated with antibiotics. At 29 weeks of gestation, she had severe hydronephrosis and severe hypertension, so we performed emergency CS.We used general anesthesia because she had had a spinal surgery, and consultation with neonatal pediatricians was necessary. Bladder injury occurred during the CS and was repaired by urologists. The outcome of the CS delivery was good, and her blood pressure recovered under therapeutic level early. However, hypertension and proteinuria persisted for about a year after the delivery. Therefore, evaluations for urinary tract infection, premature delivery, and HDP are important during the pregnancy of women with SB. In addition, severe hydronephrosis and HDP may occur. Thus, multidisciplinary treatment that includes urologists, neonatal pediatricians, anesthesiologists, and obstetricians is important to control the patients under hospital care.

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