650 failure developed immediately after cesarean delivery. We believe that the shunt failure resulted from blood sludge spilling into the peritoneal cavity during the cesarean section. Since peritoneal blood spilled during cesarean section may cause shunt obstruction, the obstetric surgeon should clean the peri- toneal cavity when a VP shunt exists. Acute obstruction of the distal catheter must be managed as an emergency because it can lead to a significant increase in the intracranial pressure. Pregnant women with CSF shunts should be managed in a routine fashion and an awareness of CSF shunt failures man- ifested by the signs of increased intracranial pressure is nec- essary to create an index of suspicion for the obstetrician. In addition, a neurosurgeon should be consulted during the an- tepartum, intrapartum, and postpartum periods. We sum- marize the recommendations for management of shunt mal- function in shunt-dependent pregnancy (Table 1). REFERENCES 1. Liakos AM, Bradley NK, Magram G, Muszynski C. Hydrocephalus and the reproductive health of women: the medical implications of maternal shunt dependency in 70 women and 138 pregnancies. Neurol Res 2000; 22: 69-88. 2. Yu JN. Pregnancy and extracranial shunts: case report and review of the literature. J Fam Pract 1994; 38: 622-6. 3. Cusimano MD, Meffe FM, Gentili F, Sermer M. Management of pregnant women with cerebrospinal fluid shunts. Pediatr Neurosurg 1991-1992; 17: 10-3. 4. Liakos AM, Bradley NK, McAllister JP, Magram G, Kinsman SL. Hydrocephalus and pregnancy: the medical implications of mater- nal shunt dependency. Eur J Pediatr Surg 1997; 7 (Suppl 1): 51-2. 5. Wisoff JH, Kratzert KJ, Handwerker SM, Young BK, Epstein F. Pregnancy in patients with cerebrospinal fluid shunts: report of a series and review of the literature. Neurosurgery 1991; 29: 827-31. S.-C. Hwang, T.-H. Kim, B.-T. Kim, et al. 6. Nugent P, Hoshek S. Large extra-abdominal cyst as a postpartum complication of peritoneal shunt. Case report. J Neurosurg 1986; 64: 151-2. 7. Bradley NK, Liakos AM, McAllister JP 2nd, Magram G, Kinsman S, Bradley MK. Maternal shunt dependency: implications for obstet- ric care, neurosurgical management, and pregnancy outcomes and a review of selected literature. Neurosurgery 1998; 43: 448-60. 8. Nfonsam V, Chand B, Rosenblatt S, Turner R, Luciano M. Laparo- scopic management of distal ventriculoperitoneal shunt complica- tions. Surg Endosc 2008; 22: 1866-70. 9. Bryant MS, Bremer AM, Tepas JJ 3rd, Mollitt DL, Nquyen TQ, Tal- bert JL. Abdominal complications of ventriculoperitoneal shunts. Case reports and review of the literature. Am Surg 1988; 54: 50-5. 10. Howard TE Jr, Herrick CN. Pregnancy in patients with ventriculoperi- toneal shunts: report of two cases. Am J Obstet Gynecol 1981; 141: 99-101. 11. Cusimano MD, Meffe FM, Gentili F, Sermer M. Ventriculoperitoneal shunt malfunction during pregnancy. Neurosurgery 1990; 27: 969-71. 12. Samuels P, Driscoll DA, Landon MB, Ludmir J, McKrisky PJ, Men- nuti MT, Gabbe SG. Cerebrospinal fluid shunts in pregnancy. Report of two cases and review of the literature. Am J Perinatol 1988; 5: 22-5. 13. Okagaki A, Kanzaki H, Moritake K, Mori T. Case report: pregnant woman with a ventriculoperitoneal shunt to treat hydrocephalus. Asia Oceania J Obstet Gynaecol 1990; 16: 111-3. 14. Kim KI, Cho KH, Kim HK, Cho KG. Ventriculoperitoneal shunt malfunction during pregnancy. J Korean Neurosurg Soc 1986; 15: 817-24. 15. Riffaud L, Ferre JC, Carsin-Nicol B, Morandi X. Endoscopic third ventriculostomy for the treatment of obstructive hydrocephalus dur- ing pregnancy. Obstet Gynecol 2006; 108: 801-4. 16. Gast MJ, Grubb RL Jr, Strickler RC. Maternal hydrocephalus and pregnancy. Obstet Gynecol 1983; 62 (3 Suppl): 29s-31s. 17. Olatunbosun OA, Akande EO, Adeoye CO. Ventriculoperitoneal shunt and pregnancy. Int J Gynaecol Obstet 1992; 37: 271-4.