もやもや病患者の妊娠・出産の管理

Pregnancy and Delivery of Patients with Moyamoya Disease

Point

・もやもや病女性が生殖可能年齢になった時点で，妊娠・出産におけるリスクに対する患者の理解を促進するとともに，薬剤調整などを行うことが望ましい．

・もやもや病女性の妊娠では，通常の妊娠と比較して妊娠高血圧症候群，脳血管イベントのリスクが高く，それに留意した管理が重要である．

・分娩時は血圧上昇による脳出血，および過換気と分娩後出血による脳梗塞に注意が必要である．

・もやもや病女性の妊娠・出産には，脳神経外科，産婦人科，麻酔科，小児科など，複数診療科の連携が不可欠である．

　Pregnancy and delivery management in patients with moyamoya disease requires careful attention because of the increased risk of cerebrovascular events. Prepregnancy evaluation, including radiological imaging, neurological assessment, and medication adjustment, is essential. During pregnancy, blood pressure（BP） should be monitored closely to prevent complications, because patients are prone to developing high BP. Delivery should be planned based on the patient's cerebrovascular condition, with vaginal delivery under epidural analgesia management or cesarean section in high-risk cases. Postpartum care includes managing BP and monitoring stroke symptoms. Multidisciplinary collaboration between obstetricians, neurologists, and anesthesiologists is crucial for optimizing outcomes.