Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-76c49bb84f-s7zp8 Total loading time: 0 Render date: 2025-07-07T16:49:57.897Z Has data issue: false hasContentIssue false

6 - Parturients of short stature

from Section 2 - Musculoskeletal disorders

Published online by Cambridge University Press:  19 October 2009

By
Andrea J. Fuller ,
Sheila E. Cohen  and
Emily F. Ratner
Edited by
David R. Gambling ,
M. Joanne Douglas  and
Robert S. F. McKay
Andrea J. Fuller
Affiliation:
Northern Colorado Anesthesia, Professional Consultants, Staff Physician, Fort Collins, CO, USA
Sheila E. Cohen
Affiliation:
Professor of Anesthesia and of Obstetrics and Gynecology, Department of Anesthesia, Stanford University School of Medicine, Stanford, CA, USA
Emily F. Ratner
Affiliation:
Associate Professor, Co-Director, Division of Medical Acupuncture, Department of Anesthesia, Stanford University, School of Medicine, Stanford, CA, USA
David R. Gambling
Affiliation:
University of California, San Diego
M. Joanne Douglas
Affiliation:
University of British Columbia, Vancouver
Robert S. F. McKay
Affiliation:
University of Kansas
Get access

Summary

Introduction

Dwarfism is defined as failure to achieve a height of 4 feet 10 inches (148 cm) at adulthood. Short stature is a clinical entity that has numerous etiologies. These conditions can be of genetic, constitutional, or metabolic origin. There are more than 100 different types of dwarfism, none of which is very common. The most common variety, achondroplasia, occurs in only 0.5 to 1.5 per 10,000 live births. Two major classifications of dwarfism are especially useful to the anesthesiologist: (1) patients with short stature who are proportionate and have normal trunk-to-limb ratio, and (2) patients who have disproportionate growth and have either short trunks in relation to their limbs or short limbs in relation to their trunks. (see Table 6.1). There are women at the lower extreme of height in some cultures who would meet the definition of dwarfism but who have no medical pathology. Their treatment must be individualized bearing in mind that they may be similar in some respects to parturients with proportionate dwarfism.

Since the formation of the Little People of America, a society for people of short stature, and even dedicated online dating services, much greater opportunity exists for dwarfs to meet, socialize, and eventually have children. In addition, increased use of assisted reproductive technology is enabling women of short stature who were otherwise infertile to achieve pregnancy and even multiple gestations.

Information

Type
Chapter
Information
Obstetric Anesthesia and Uncommon Disorders , pp. 115 - 128
Publisher: Cambridge University Press
Print publication year: 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Book purchase

Temporarily unavailable

References

Tyson, J. E., Barnes, A. C., McKusick, V. A.et al. Obstetric and gynecologic considerations of dwarfism. Am. J. Obstet. Gynecol. 1970; 108: 688–703.Google Scholar
Berkowitz, I. D., Raja, S. N., Bender, K. S.et al. Dwarfs: pathophysiology and anesthetic implications. Anesthesiology 1990; 73: 739–59.Google Scholar
Orioli, I. M., Castilla, E. E. & Barbosa-Neto, J. G.The birth prevalence rates for the skeletal dysplasias. J. Med. Genet. 1986; 23: 328–32.Google Scholar
Boer, H. D., Hemelaar, A., Dongen, R. & Gielen, M. J.Successful epidural anaesthesia for Caesarean section in a patient with spondyloepiphyseal dysplasia. Br. J. Anaesth. 2001; 86: 133–4.Google Scholar
Vogel, T. M., Ratner, E. F., Thomas, R. C. & Chitkara, U.Pregnancy complicated by severe osteogenesis imperfecta: a report of two cases. Anesth. Analg. 2002; 94: 1315–17.CrossRefGoogle Scholar
Bailey, J. A.Disproportionate Short Stature: Diagnosis and Management. Philadelphia, PA: W B Saunders Co, 1973.
Phillips, J. A. Inherited defects in growth hormone synthesis and action. In Scriver, C. R., Baudet, A. L., Valle, D.et al. (eds.) The Metabolic and Molecular Basis of Inherited Disease, 7th edn. New York, NY: McGraw Inc, 1995.
Rimoin, D. L., Holzman, G. B., Merimee, T. J.et al. Lactation in the absence of human growth hormone. J. Clin. Endocrinol. 1968; 28: 1183–8.Google Scholar
Rimoin, D. L., Merimee, T. J. & McKusick, V. A.Growth-hormone deficiency in man: an isolated, recessively inherited defect. Science 1966; 152: 1635–7.Google Scholar
Amselem, S., Duquesnoy, P., Attree, O.et al. Laron dwarfism and mutations of the growth hormone-receptor gene. N. Engl. J. Med. 1989; 321: 989–95.Google Scholar
Dorland's Illustrated Medical Dictionary. 26th edn. Philadelphia, PA: W B Saunders Co, 1981.
Menashe, Y., Sack, J. & Mashiach, S.Spontaneous pregnancies in two women with Laron-type dwarfism: are growth hormone and circulating insulin-like growth factor mandatory for induction of ovulation?Hum. Reprod. 1991; 6: 670–1.CrossRefGoogle Scholar
Cheek, T. G. & Gutsche, B. B. Maternal physiologic alterations during pregnancy. In Shnider, S. M. & Levinson, G. (eds.), Anesthesia for Obstetrics, 3rd edn. Baltimore: Williams and Wilkins, 1993, p. 3.
Allanson, J. E. & Hall, J. G.Obstetric and gynecologic problems in women with chondrodystrophies. Obstet. Gynecol. 1986; 67: 74–8.Google Scholar
Muller, J., Starup, J., Christiansen, J. S.et al. Growth hormone treatment during pregnancy in a growth hormone-deficient woman. Eur. J. Endocrinol. 1995; 132: 727.Google Scholar
Ratner, E. & Hamilton, C. L.Anesthesia for cesarean section in a pituitary dwarf. Anesthesiology 1998; 89: 253–4.Google Scholar
Kornreich, L., Horev, G., Schwarz, M., Karmazyn, B. & Laron, Z.Laron syndrome abnormalities: spinal stenosis, os odontoideum, degenerative changes of the atlanto-odontoid joint, and small oropharynx. Am. J. Neuroradiol. 2002; 23: 625–31.Google Scholar
Moore, D. C. & Batra, M. S.The components of an effective test dose prior to epidural block. Anesthesiology 1981; 55: 693–6.Google Scholar
Benson, K. T., Dozier, N. J., Goto, H. & Arakawa, K.Anesthesia for cesarean section in a patient with spondylometepiphyseal dysplasia. Anesthesiology 1985; 63: 548–50.Google Scholar
Cohen, S. E.Anesthesia for cesarean section in achondroplastic dwarfs. Anesthesiology 1980; 52: 264–6.Google Scholar
Brimacombe, J. R. & Caunt, J. A.Anaesthesia in a gravid achondroplastic dwarf. Anaesthesia 1990; 45: 132–4.Google Scholar
Maroteaux, P.International nomenclature of constitutional diseases of bones with bibliography. Birth Defects 1986; 22: 1–54.Google Scholar
Francomano, C. A.The genetic basis of dwarfism. N. Engl. J. Med. 1995; 332: 58–9.Google Scholar
Walts, L. F., Finerman, G. & Wyatt, G. M.Anaesthesia for dwarfs and other patients of pathological small stature. Can. Anaesth. Soc. J. 1975; 22: 703–9.Google Scholar
Mayhew, J. F., Katz, J., Miner, M.et al. Anaesthesia for the achondroplastic dwarf. Can. Anaesth. Soc. J. 1986; 33: 216–21.Google Scholar
Monedero, P., Garcia-Pedrajas, F., Coca, I.et al. Is management of anesthesia in achondroplastic dwarfs really a challenge?J. Clin. Anesth. 1997; 9: 208–12.Google Scholar
Mather, J. S.Impossible laryngoscopy in achondroplasia: A case report. Anaesthesia 1966; 21: 244–8.Google Scholar
Anasari, M. H. & Abraham, A.Anaesthetic management of unexpected subglottic stenosis in an achondroplastic dwarf. Acta Anaesthesiol. Scand. 2004; 48: 928.Google Scholar
Nelson, M. A.Spinal stenosis in achondroplasia. Proc. R. Soc. Med. 1972; 65: 1028–9.Google Scholar
Yang, S. S., Corbett, D. P., Brough, A. J.et al. Upper cervical myelopathy in achondroplasia. Am. J. Clin. Path. 1977; 68: 68–72.Google Scholar
Morgan, D. F. & Young, R. F.Spinal neurological complications of achondroplasia. J. Neurosurg. 1980; 52: 463–72.CrossRefGoogle Scholar
Schreiber, F. & Rosenthal, H.Paraplegia from ruptured lumbar discs in achondroplastic dwarfs. J. Neurosurg. 1952; 9: 648–51.Google Scholar
Wynne-Davies, R., Walsh, W. K. & Gormley, J.Achondroplasia and hypochondroplasia. J. Bone Joint Surg. 1981; 63B: 508–15.Google Scholar
Bergstrom, K., Laurent, U. & Lundberg, P. O.Neurological symptoms in achondroplasia. Acta Neurol. Scand. 1971; 47: 59–70.Google Scholar
Alexander, E.Significance of the small lumbar spinal canal: cauda equina compression syndromes due to spondylosis: Part 5. Achondroplasia. J. Neurosurg. 1969; 31: 513–19.CrossRefGoogle Scholar
Lutter, L. D., Lonstein, J. E., Winter, R. B.et al. Anatomy of the achondroplastic lumbar canal. Clin. Orthop. Rel. Res. 1977; 126: 139–42.Google Scholar
Cohen, M. E., Rosenthal, A. D. & Matson, D. D.Neurological abnormalities in achondroplastic children. J. Pediatr. 1967; 71: 367–76.CrossRefGoogle Scholar
Ozer, F. L.Achondroplasia with spinal neurologic complications in mother and son: case report. Birth Defects 1974; 10: 31–5.Google Scholar
Lutter, L. D. & Langer, L. O.Neurological symptoms in achondroplastic dwarfs: surgical treatment. J. Bone Joint Surg. 1977; 59A: 87–92.Google Scholar
Vogl, A. & Osborne, R. L.Lesions of the spinal cord (transverse myelopathy) in achondroplasia. Arch. Neurol. Psychiatr. 1949; 61: 644.Google Scholar
Moen, V., Dahlgren, N. & Irestedt, L.Severe neurological complications after central neuraxial blockades in Sweden 1990–1999. Anesthesiology 2004; 101: 950–9.Google Scholar
Fremoin, A. S., Garg, B. P. & Kalsbeck, J.Apnea as the sole manifestation of cord compression in achondroplasia. J. Pediatr. 1984; 104: 398.Google Scholar
Reid, C. S., Pyeritz, R. E., Kopits, S. E.et al. Cervicomedullary compression in young patients with achondroplasia. Value of comprehensive neurologic and respiratory evaluation. J. Pediatr. 1987; 110: 522–30.CrossRefGoogle Scholar
Kopits, S. E.Orthopedic complications of dwarfism. Clinical Orthopedics 1976; 114: 153–79.Google Scholar
Bethem, D., Winter, R. B., Lutter, L.et al. Spinal disorders of dwarfism. J. Bone Joint Surg. 1981; 63A: 1412–25.Google Scholar
Steinbok, P., Hall, J. & Flodmark, O.Hydrocephalus in achondroplasia. The possible role of intracranial venous hypertension. J. Neurosurg. 1989; 71: 42–8.Google Scholar
Thomas, I. T., Frias, J. L., Williams, J. L. & Friedman, W. A.Magnetic resonance imaging in the assessment of medullary compression in achondroplasia. Am. J. Dis. Child. 1988; 142: 989–92.Google Scholar
Friedman, W. A. & Mickle, J. P.Hydrocephalus in achondroplasia: a possible mechanism. Neurosurg. 1980; 7: 150–3.Google Scholar
Stokes, D. C., Phillips, J. A., Leonard, C. O.et al. Respiratory complications of achondroplasia. J. Pediatr. 1983; 102: 534–41.CrossRefGoogle Scholar
McKusick, V. A.Heritable Disorders of Connective Tissue, 5th edn. St Louis: C V Mosby, 1993.
Hull, D. & Barnes, N. D.Children with small chests. Arch. Dis. Child. 1972; 47: 12.Google Scholar
Guilleminault, C., Kurland, G., Winkle, R.et al. Severe kyphoscoliosis, breathing and sleep. Chest 1981; 79: 626–30.Google Scholar
Stokes, D. C., Pyeritz, R. E., Wisa, R. A.et al. Spirometry and chest wall dimensions in achondroplasia. Chest 1988; 93: 364–9.Google Scholar
Kalla, G. N., Fening, E., Obiaya, M. O.Anaesthetic management of achondroplasia. Br. J. Anaesth. 1986; 58: 117–19.Google Scholar
Mueller, S. M., Bell, W., Cornell, S.et al. Achondroplasia and hydrocephalus. Neurology 1977; 27: 430–4.Google Scholar
Smith, T. H., Baska, R. E., Francisco, C. B.et al. Sleep apnea syndrome: diagnosis of upper airway obstruction by fluoroscopy. J. Pediatr. 1978; 93: 891–2.CrossRefGoogle Scholar
Levin, D. L., Muster, A. J., Pachman, L. M.et al. Cor pulmonale secondary to upper airway obstruction. Chest 1975; 68: 166.Google Scholar
Myer, C. M. & Cotton, R. T.Laryngotracheal stenosis in spondyloepiphyseal dysplasia. Laryngoscope 1985; 95: 3–5.Google Scholar
Spranger, J. Spondyloepiphyseal dysplasia congenita. In Bergsma, D. (ed.), Birth Defects Compendium. London, UK: Macmillan Press, 1979.
Wynne-Davis, R., Hall, C. M. & Apley, A. G.Skeletal dysplasia group: instability of the upper cervical spine. Arch. Dis. Child. 1989; 64: 283.Google Scholar
Anderson, C. E., Sillence, D. O., Lachman, R. S.et al. Spondylometaphyseal dysplasia, Strudwick type. Am. J. Med. Gen. 1982; 13: 243–56.Google Scholar
Kumar, M. & Forster, M. R.Combined spinal epidural anaesthesia for elective caesarean section in a patient with spondylometaphyseal dysplasia. Int. J. Obstet. Anesth. 2002; 11: 225–7.Google Scholar
Rodney, G. E., Callander, C. C. & Harmer, M.Spondyloepiphyseal dysplasia congenita: Caesarean section under epidural anaesthesia. Anaesthesia 1991; 46: 648–50.Google Scholar
Perovic, M. N., Kopits, S. E. & Thompson, R. C.Radiological evaluation of the spinal cord in congenital atlanto-axial dislocation. Radiology 1973; 109: 713–16.Google Scholar
Redl, G.Massive pyramidal tract signs after endotracheal intubation: a case report of spondyloepiphyseal dysplasia congenita. Anesthesiology 1998; 89: 1262–4.Google Scholar
Davison, J. J., Davison, M. C. & Hay, D. M.Gastric emptying time in late pregnancy and labour. J. Obstet. Gynaecol. Brit. Commonw. 1970; 77: 37.Google Scholar
Cohen, S. E.The aspiration syndrome. Clin. Obstet. Gynaecol. 1982; 9: 235–7.Google Scholar
Carstoniu, J., Yee, I. & Halpern, S.Epidural anaesthesia for Caesarean section in an achondroplastic dwarf. Can. J. Anaesth. 1992; 39: 708–11.Google Scholar
McArthur, R. D.Obstetric anaesthesia in an achondroplastic dwarf at a regional hospital. Anaesth. Intensive Care 1992; 20: 376–8.Google Scholar
Bancroft, G. H. & Lauria, J. I.Ketamine induction for cesarean section in a patient with acute intermittent porphyria and achondroplastic dwarfism. Anesthesiology 1983; 59: 143–4.Google Scholar
Wardall, G. J. & Frame, W. T.Extradural anaesthesia for caesarean section in achondroplasia. Br. J. Anaesth. 1990; 64: 367–70.CrossRefGoogle Scholar
Crawford, M. & Dutton, D. A.Spinal anaesthesia for caesarean section in an achondroplastic dwarf (letter). Anaesthesia 1992; 47: 1007.Google Scholar
Ravenscroft, A., Covender, T. & Rout, C.Spinal anesthesia for emergency cesarean section in an achondroplastic dwarf. Anaesthesia 1998; 53: 1236–7.Google Scholar
Morrow, M. J. & Black, I. H.Epidural anaesthesia for Caesarean section in an achondroplastic dwarf. Br. J. Anaesth. 1998; 81: 619–21.CrossRefGoogle Scholar
Trikha, A., Goyal, K., Sadera, G. S. & Singh, M.Combined spinal epidural anaesthesia for vesico-vaginal fistula repair in an achondroplastic dwarf. Anaesth. Intensive Care 2002; 30: 96–8.Google Scholar
Auden, S. M.Cervical spine instability and dwarfism: fiberoptic intubations for all. Anesthesiology 1999; 91: 580.Google Scholar
Waugaman, W. R., Kryc, J. J. & Andrews, M. J.Epidural anesthesia for cesarean section and tubal ligation in an achondroplastic dwarf. J. Am. Assoc. Nurse Anesth. 1986; 54: 436–7.Google Scholar
Rigler, M. L., Drasner, K., Krejcie, T. C.et al. Cauda equina syndrome after continuous spinal anesthesia. Anesth. Analg. 1991; 72: 275–81.Google Scholar
Rigler, M. L. & Drasner, K.Distribution of catheter-injected local anesthetic in a model of the subarachnoid space. Anesthesiology 1991; 75: 684–92.Google Scholar
Cooley, S. M., O'Connell, M. P. & Keane, D.Marshall Smith Syndrome and pregnancy. J. Obstet. Gynaecol. 2004; 24: 181.Google Scholar
Ayoubi, J. M., Pierre-Simon, J. & Pons, J. C.Diastrophic dwarfism and pregnancy. Lancet 2001; 358: 1778.Google Scholar
Lahiri, S. & Davies, N.Cockayne's Syndrome: case report of a successful pregnancy. Br. J. Obstet. Gynecol. 2003; 110: 871–2.Google Scholar
Michel, T. C., Rosenberg, A. L. & Polley, L. S.Obstetric anesthetic management of a parturient with Larsen syndrome and short stature. Anesth. Analg. 2001; 92: 1266–7.CrossRefGoogle Scholar

Accessibility standard: Unknown

Accessibility compliance for the PDF of this book is currently unknown and may be updated in the future.

Save book to Kindle

To save this book to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

  • Parturients of short stature
    • By Andrea J. Fuller, Northern Colorado Anesthesia, Professional Consultants, Staff Physician, Fort Collins, CO, USA, Sheila E. Cohen, Professor of Anesthesia and of Obstetrics and Gynecology, Department of Anesthesia, Stanford University School of Medicine, Stanford, CA, USA, Emily F. Ratner, Associate Professor, Co-Director, Division of Medical Acupuncture, Department of Anesthesia, Stanford University, School of Medicine, Stanford, CA, USA
  • Edited by David R. Gambling, University of California, San Diego, M. Joanne Douglas, University of British Columbia, Vancouver, Robert S. F. McKay, University of Kansas
  • Book: Obstetric Anesthesia and Uncommon Disorders
  • Online publication: 19 October 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511544552.007
Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

  • Parturients of short stature
    • By Andrea J. Fuller, Northern Colorado Anesthesia, Professional Consultants, Staff Physician, Fort Collins, CO, USA, Sheila E. Cohen, Professor of Anesthesia and of Obstetrics and Gynecology, Department of Anesthesia, Stanford University School of Medicine, Stanford, CA, USA, Emily F. Ratner, Associate Professor, Co-Director, Division of Medical Acupuncture, Department of Anesthesia, Stanford University, School of Medicine, Stanford, CA, USA
  • Edited by David R. Gambling, University of California, San Diego, M. Joanne Douglas, University of British Columbia, Vancouver, Robert S. F. McKay, University of Kansas
  • Book: Obstetric Anesthesia and Uncommon Disorders
  • Online publication: 19 October 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511544552.007
Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

  • Parturients of short stature
    • By Andrea J. Fuller, Northern Colorado Anesthesia, Professional Consultants, Staff Physician, Fort Collins, CO, USA, Sheila E. Cohen, Professor of Anesthesia and of Obstetrics and Gynecology, Department of Anesthesia, Stanford University School of Medicine, Stanford, CA, USA, Emily F. Ratner, Associate Professor, Co-Director, Division of Medical Acupuncture, Department of Anesthesia, Stanford University, School of Medicine, Stanford, CA, USA
  • Edited by David R. Gambling, University of California, San Diego, M. Joanne Douglas, University of British Columbia, Vancouver, Robert S. F. McKay, University of Kansas
  • Book: Obstetric Anesthesia and Uncommon Disorders
  • Online publication: 19 October 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511544552.007
Available formats
×