Choice of therapy and mode of delivery in idiopathic intracranial hypertension during pregnancy

Abstract

Benign intracranial hypertension (BIH) or idiopathic intracranial hypertension (IIH) is a rare disorder of unknown etiology that is most often seen in obese women of reproductive age (19.3/100,000) and is reported only occasionally during pregnancy. Both pregnancy and exogenous estrogens are thought to promote IIH or worsen it. It can occur in any trimester during pregnancy, and the visual outcome is the same as for nonpregnant patients with IIH. There is no increase in fetal wastage; therapeutic abortion to limit its progression is not indicated, and subsequent pregnancies do not increase the risk of recurrence. Most therapies used during the nonpregnant state can also be used during pregnancy. The aim of treatment is to preserve vision and improve symptoms. Treatments include analgesics, diuretics, steroids, and serial lumbar punctures. When medical therapy fails, surgical procedures need to be considered. Although this condition has been reviewed often, the issue of mode of delivery, especially when papilledema has not resolved, is unclear. We report on 3 women with IIH during pregnancy and review the choice of therapy and mode of delivery.