Management of Pregnancy in Patients With an Implanted Spinal Cord Stimulator: A European Expert Survey

Spinal cord stimulation (SCS) is a surgical treatment for severe chronic neuropathic pain and is a common procedure in women of child-bearing age. Theoretical concerns about the safety of active SCS treatment during pregnancy have led to a widespread practice of recommending deactivation of SCS in pregnant women. The presence of an SCS device also has implications for anesthetic management during labor.

An online questionnaire-based expert survey was conducted among centers in the Nordic countries, Benelux, and Germany, a territory with a population of 140 million. Questions covered details on the centers, experience with and clinical practice in managing pregnant patients with SCS, anesthetic management in labor, and surgical practice in women of child-bearing age.

Overall, 158 centers were contacted, and 78 (49%) responded. Most respondents were anesthetists or neurosurgeons working at public hospitals; 60% had managed pregnant patients with SCS; of those respondents, two-thirds had been contacted by anesthetists and/or obstetricians regarding management of pregnancy and labor. One-third of respondents recommended deactivation of SCS during pregnancy; notably, only one respondent-the author-encountered possible complications of SCS in pregnancy. Disagreement exists regarding neuraxial block; 95% of respondents were SCS implanters, but only one-fourth took special precautions during SCS implantation to facilitate the safety of future pregnancies and deliveries.

Pregnancy in patients with SCS is subject to wide variation in recommendations to patients and obstetric anesthetists, and in surgical practice. The survey results do not support concerns of continued SCS therapy during pregnancy, but systematic follow-up data are warranted. In addition, the data contribute to the overview of organization of SCS therapy in Northwest Europe.