Anesthetic Approach of Pregnant Woman with Cerebral Arteriovenous Malformation and Subarachnoid Hemorrhage during Pregnancy: Case Report

Carvalho, Catarina Santos; Resende, Filipa; Centeno, Maria João; Ribeiro, Ícaro José Santos; Moreira, João

doi:10.1016/j.bjane.2012.05.004

Cited by 13 publications

(16 citation statements)

References 12 publications

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“…Sixty-five cases in 35 articles were calculated and analyzed in this study. 1,3–5,10–40 A total of 125 articles (76 non-pertinent, 21 reviews, 11 non-eligible and 23 other than English language) were excluded from a total of 160 articles.…”

Section: Methodsmentioning

confidence: 99%

Pre-existing, incidental and hemorrhagic AVMs in pregnancy and postpartum: Gestational age, morbidity and mortality, management and risk to the fetus

Liu

2015

Interv Neuroradiol

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Objective The objective of this article is to analyze the maternal and fetal outcomes of pregnancies that present with arteriovenous malformations (AVMs). Methods A literature review was performed that analyzed 65 cases of AVM during pregnancy previously reported in English literature. Results Sixty-five cases of pregnancy-associated AVM were identified. The patients’ ages ranged from 16 to 45 years, with a mean of 28 ± 4.9 years. Sixteen cases (24.6%) were pre-existing AVMs. There were 54 cases (83.1%) of AVM ruptured during pregnancy and postpartum: Six cases (11.1%) were in the first trimester, 24 (44.4%) were in the second, 22 (40.7%) were in the third trimester and two (3.7%) were postpartum. Unfavorable maternal clinical outcome (modified Rankin Scale (mRS) ≥ 2) was identified in 20 cases (30.8%) and abortion occurred in 10 cases (15.4%). There were three maternal deaths, yielding a case mortality rate of 4.6%. Fifty-three fetuses were born via cesarean section in 42 cases and vaginal delivery in 10 cases; 48 were in good health, three were temporarily intubated, one was macrosomic and one died. In univariate analysis, AVM hemorrhage presentation was significantly associated with a poor maternal outcome (mRS ≥ 2) ( p = 0.030); however, not significantly associated with fetus risk ( p = 0.864). Gestational age was not significantly associated with poor maternal outcome ( p = 0.875) or fetal risk ( p = 0.790). Conclusion AVM hemorrhage presentation was significantly associated with poor maternal outcome. Pre-existing ruptured AVM may not be associated with fetal risk. Gestational age of AVM rupture was not significantly associated with poor maternal outcome or fetal risk.

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Section: Methodsmentioning

confidence: 99%

Pre-existing, incidental and hemorrhagic AVMs in pregnancy and postpartum: Gestational age, morbidity and mortality, management and risk to the fetus

Liu

2015

Interv Neuroradiol

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“…Anesthesia should maintain the stability of the cardiovascular system during childbirth, avoiding hypotension reducing the uteroplacental blood perfusion and hypertension increasing bleeding risk of cerebral AVM. 12…”

Section: Clinical Characteristicsmentioning

confidence: 99%

“…Cesarean section was selected in some cases, but there is still a lack of studies about the delivery mode and AVM bleeding risk. 2,3,6,12,31 Although AVM rupture in the childbirth process does not seem to increase, cesarean section can control the maternal blood pressure and avoid brief and intense hemodynamic changes of intracranial vascular pressure, which could lead to an increase of the stress that the vessel wall will bear. If the AVM has been completely removed, the method of delivery should accord with the obstetric indications.…”

Section: Obstetrical Treatmentmentioning

confidence: 99%

The clinical characteristics and treatment of cerebral AVM in pregnancy

2015

Neuroradiol J

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Cerebral arteriovenous malformation (AVM) in pregnancy is a complex situation and there is no agreement on its hemorrhage risk and treatment. Although studies on bleeding risk of cerebral AVMs in pregnancy are very few and there are different results between them, pregnancy will increase the hemorrhagic risk of AVM, and ruptured cerebral AVM in pregnancy should be treated actively. After intracranial hemorrhage, cerebral angiography should be performed for pregnant women shielded correctly. Cerebral angiography could clearly demonstrate the characteristics of cerebral AVM. The results from the literature show that the radiation dose of endovascular and stereotactic radiotherapy for cerebral AVM in pregnancy is below the safety value and is safe. Unruptured AVM in pregnancy, if there is no bleeding factor, such as no coexisting aneurysm, smooth venous drainage, no venous ectasia, or high risk of treatment, should be observed conservatively.

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“…Pregnancy as such does not have any influence on the progression of this disease. Ruptured AVM contributes to 50% of SAH, [23] which occurs in pregnancy and responsible for 5-12% maternal mortality. Intracranial AVM can be supratentorial, infratentorial or located deep inside brain structures.…”

Section: Arteriovenous Malformationmentioning

confidence: 99%