HS Yoo, et al / Pregnancy in Woman with Spinal Cord Stimulator 269 We believe that there must be a guideline concerning the treatment of chronic pain in patients expecting a future pregnancy. These patients must be informed that SCS de- vice implantation can replace the disadvantages of using teratogenic analgesics. In addition, postpartum follow-up, with special emphasis on the SCS function, must be documented. Informed consent should be obtained regard- ing the possibility of disrupting the function of the SCS and due to infection risk. Postoperatively, the clinical efficacy of SCS should be checked by the neurostimulator as any device or programming issues can be identified in this manner. Most importantly, cautious follow up visits to the obstetric department throughout the pregnancy are abso- lutely necessary. In conclusion, SCS is not recommended in pregnancy because the effects of SCS on pregnancy and nursing mothers have not been studied. However, many female pa- tients suffering from chronic pain may expect future preg- nancy, and we think that they must be informed about the possibility of pregnancy and the effects of the SCS device implantation during the course of their pregnancy. We also hope that this report will elicit the interest of physicians to report other cases involving the conception, pregnancy, and labor management of patients with spinal cord stim- ulators in order to confirm the safety of this modality un- der these circumstances. REFERENCES 1. Manchikanti L, Datta S, Gupta S, Munglani R, Bryce DA, Ward SP, et al. A critical review of the American Pain Society Clinical practice guidelines for interventional techniques: part 2. Therapeutic interventions. Pain Physician 2010; 13: E215-64. 2. Jeon Y, Huh BK. Spinal cord stimulation for chronic pain. Ann Acad Med Singapore 2009; 38: 998-1003. 3. Linderoth B, Foreman RD. Mechanisms of spinal cord stimulation in painful syndromes: role of animal models. Pain Med 2006; 7(Suppl 1): S14-26. 4. North R, Shipley J, Prager J, Barolat G, Barulich M, Bedder M, et al. Practice parameters for the use of spinal cord stimulation in the treatment of chronic neuropathic pain. Pain Med 2007; 8(Suppl 4): S200-75. 5. Kumar K, Taylor RS, Jacques L, Eldabe S, Meglio M, Molet J, et al. Spinal cord stimulation versus conventional medical management for neuropathic pain: a multicentre randomised controlled trial in patients with failed back surgery syndrome. Pain 2007; 132: 179-88. 6. Taylor RS. Spinal cord stimulation in complex regional pain syndrome and refractory neuropathic back and leg pain/failed back surgery syndrome: results of a systematic review and meta-analysis. J Pain Symptom Manage 2006; 31(4 Suppl): S13-9. 7. Segal R. Spinal cord stimulation, conception, pregnancy and labor: case report. Neuromodulation 1999; 2: 41-5. 8. Hanson JL, Goodman EJ. Labor epidural placement in a woman with a cervical spinal cord stimulator. Int J Obstet Anesth 2006; 15: 246-9. 9. Saxena A, Eljamel MS. Spinal cord stimulation in the first two trimesters of pregnancy: case report and review of the literature. Neuromodulation 2009; 12: 281-3. 10. Sommerfield D, Hu P, O'Keeffe D, McKeating AK. Caesarean section in a parturient with a spinal cord stimulator. Int J Obstet Anesth 2010; 19: 114-7. 11. Park HJ, Moon DE. Pharmacologic management of chronic pain. Korean J Pain 2010; 23: 99-108. 12. Lucas S. Medication use in the treatment of migraine during pregnancy and lactation. Curr Pain Headache Rep 2009; 13: 392-8. 13. Kubista E. The influence of transcutaneous nerve stimulation (TNS) on hormonal parameters of placental function in cases of placental insufficiency (author's transl). Z Geburtshilfe Perinatol 1981; 185: 151-4. 14. Arck PC, Rücke M, Rose M, Szekeres-Bartho J, Douglas AJ, Pritsch M, et al. Early risk factors for miscarriage: a prospective cohort study in pregnant women. Reprod Biomed Online 2008; 17: 101-13. 15. Davies RG. Deep brain stimulators and anaesthesia. Br J Anaesth 2005; 95: 424. 16. Weaver J, Kim SJ, Lee MH, Torres A. Cutaneous electro- surgery in a patient with a deep brain stimulator. Dermatol Surg 1999; 25: 415-7. 17. Martinelli PT, Schulze KE, Nelson BR. Mohs micrographic surgery in a patient with a deep brain stimulator: a review of the literature on implantable electrical devices. Dermatol Surg 2004; 30: 1021-30. 18. Siddiqui MA, Khan IA. Differential electrocardiographic artifact from implanted spinal cord stimulator. Int J Cardiol 2003; 87: 307-9.