Cesarean section in women with MS: a choice or a need?

Management of pregnancy related issue in women affected by Multiple Sclerosis, requires a multidisciplinary approach. Labour represents a critical moment for both the woman and the newborn, therefore a delicate choice has to be made in agreement with both treating physicians, gynaecologist and neurologist. Several aspects related to pregnancy have been investigated in MS, however little attention has been devoted to the modality of delivery. Objectives: To investigate whether the diagnosis of MS influences delivery modality. Methods: We retrospectively analysed data from a cohort of full ambulatory women attending the MS centre of Sant'Andrea Hospital in Rome. Data on reproductive history, pregnancy, miscarriages and pregnancy interruption were collected by the means of a questionnaire with the supervision of an obstetrician. Data on disease history were collected from patient's clinical record. To serve as control, data on delivery of healthy subjects (HS) were collected from clinical registry of Fabia Mater clinic in Rome. Results: We collected data on pregnancy from 250 HS and 157 patients (mean age 33±5.8; 30±5.8 years respectively); 76 patients (mean age 32,7±5) presented a diagnosis before pregnancy (MSpre). Considering all patients with MS, gestational weeks and birth weight were lower compared with HS (38,4 ±1,7 vs39,3±1,3 weeks p =0,001 and 3092±519 vs 3290±446 g p< 0,001 respectively). Compared with HS, the MSpre group showed a lower frequency of natural delivery and a higher frequency of both planned and urgency caesarean section (39,3%vs66%; 32,7%vs22.4% and 24,5% vs 9,2%respectively, p< 0,001). Conclusions: Women with a diagnosis of MS are more subject to cesarean section. This can recognize two possible causes: an aprioristic choice of the gynaecologist and complication during natural delivery.