I realize that I might get hammered for posting this without having all of the facts, but here we go.

Whilst scampering between cases today I heard about this case. A full term parturient presents in labor. She has a VP shunt which was apparently placed for hydrocephalus. She has “some” altered mental status (I did not get a clear definition of this.....sorry). The thought was that the shunt was not working properly due to increased abdominal pressures secondary to the pregnancy. The MDA on duty declined to place a labor epidural out of concern that the epidural might increase ICP and further exacerbate the mental status changes.

1) Reasonable or unreasonable concern?
2) What about a spinal should she present for c-section?
3) Is the presence of a VP shunt a contraindication to either epidural or Spinal?
4) What about increased ICP, is that a contraindication?
5) Any other concerns?

For the sake of this discussion, let’s assume otherwise healthy?