Letter to the Editor regarding “Chiari I malformation and pregnancy: a comprehensive review of the literature to address common questions and to guide management.”

Dear Editor:

We read with interest this comprehensive review by Sastry et al. [1] on the optimal management of pregnant women with Chiari I malformation. Given the uncertainty on the optimal management and the high stakes of adverse maternal outcomes, we agree with the authors on the need for a multidisciplinary careful evaluation of maternal symptoms early-on in pregnancy to plan intrapartum care accordingly and mitigate ensuing risks.

We recently published our local experience as a tertiary referral centre in the UK presenting data on 21 women with 23 pregnancies over a 14-year period [2]. While, sadly, our data was not included in this review, we largely concur with the author about the relative safety of vaginal delivery with neuraxial anaesthesia. Our data included 65.2% normal vaginal deliveries and 26.1% elective caesarean sections, with no neurological sequalae recorded. We hope our contribution would help the readers and practicing physicians to gain a wider perspective on this issue and offer safe care to women with Chiari I malformation.

Yours faithfully,

Dr. Joanna C. Roper and Dr. Bassel H. Al Wattar