Aneurysmal subarachnoid haemorrhage in pregnancy

Selo-Ojeme, Dan; Marshman, Laurence A.G.; Ikomi, Amaju; Ojutiku, Dale; Aspoas, Robert; Chawda, Sanjiv; Bawa, Gursharan P.S.; Manjit, S.

doi:10.1016/j.ejogrb.2004.04.016

Cited by 59 publications

(46 citation statements)

References 90 publications

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“…Although intracranial aneurysms are uncommon during pregnancy, normal hemodynamic changes in pregnant women may increase vascular stress and the risk of aneurysm formation, progression and rupture (35,44,47). Systemically, maternal adaptations to pregnancy include increases in cardiac output (CO) and plasma volume (PV), and a redistribution of the CO between various organs (43).…”

Section: Introductionmentioning

confidence: 99%

The management of intracranial aneurysms during pregnancy: a systematic review

Barbarite

Hussain

Dellarole

et al. 2015

Turkish Neurosurgery

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It has been estimated that 1.8% of women of childbearing age (16 to 44 years) develop intracranial aneurysms, however the incidence of unruptured intracranial aneurysms during pregnancy is not well established in the literature (25). Rupture of intracranial aneurysms occurs in the range of 1 to 10 per 100,000 pregnancies (1, 33). Case fatality from subarachnoid hemorrhage during pregnancy is reported as high as 83%, but outcomes have improved with better medical care (10, 12). Cerebrovascular management of aneurysms during pregnancy is complicated by the nature of maternal hemodynamics and their intimate relationship to the developing child. Given the dependence of the fetus on its mother, and the importance of a stable environment during fetal development, risk reduction from an intracranial aneurysm must clearly focus on both the mother and the child (39,40,42). Whether these aneurysms █ INTRODUCTIONAlthough intracranial aneurysms are uncommon during pregnancy, normal hemodynamic changes in pregnant women may increase vascular stress and the risk of aneurysm formation, progression and rupture (35,44,47). Systemically, maternal adaptations to pregnancy include increases in cardiac output (CO) and plasma volume (PV), and a redistribution of the CO between various organs (43). Cerebrovascular changes are thought to result from hormones that increase during pregnancy, such as estrogen, progesterone, and vascular endothelial growth factor (36). Other reported factors that may potentiate aneurysm progression during pregnancy include high levels of relaxin and increased wall tension from intraparenchymal artery hypoplasia (6, 51).Hemodynamic changes during pregnancy may favor the formation and rupture of intracranial aneurysms. Despite this risk, guidelines for managing intracranial aneurysms during pregnancy have not been clearly defined. The objective of this review is to describe the treatment options for pregnant women with intracranial aneurysms, and to report the maternal and fetal outcomes associated with different treatment strategies. A search of the literature was conducted using the PubMed database for the period January 1991 through June 2015. Aneurysm characteristics and management, pregnancy management, and maternal and fetal outcomes were evaluated. The most recent search was performed in June 2015. In total, 50 aneurysms (44 patients) were evaluated. Rupture was confirmed upon imaging in 36 aneurysms (72%), and most aneurysms ruptured during the third trimester (77.8%). Coil embolization was associated with a lower complication rate than clipping in patients with ruptured aneurysms (9.5% vs 23.1%). For patients with unruptured aneurysms, surgical management was associated with 31.9% fewer complications compared to no treatment. Most patients underwent Cesarean delivery (84%), and a combined neurosurgical-obstetrical procedure was used for 8 patients with ruptured aneurysms near term. Adverse outcomes were reported in 11.9% of children. Treatment of intracranial aneurysms during pregnancy is sa...

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Section: Introductionmentioning

confidence: 99%

The management of intracranial aneurysms during pregnancy: a systematic review

Barbarite

Hussain

Dellarole

et al. 2015

Turkish Neurosurgery

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“…Ruptured aneurysms during pregnancy should be treated, surgically or by coiling. If the gestational age allows, it is better to carry out the delivery by caesarean before aneurysmal treatment [75,83].…”

Section: Pregnancymentioning

confidence: 99%

Update on subarachnoid haemorrhage

2008

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Subarachnoid haemorrhage (SAH) is less frequent than ischaemic stroke or intracerebral haemorrhage, but has a high public health relevance because it can affect young and middle-age adults, has considerable mortality and morbidity, it is treatable and preventable. SAH is traditionally a topic for neurosurgeons. However as endovascular interventions are becoming effective alternatives to surgical treatment, SAH should turn out to be of interest to neurologists, in particular to those devoted to stroke, emergency and neurointensive care. Despite stable incidence, the mortality of SAH has decreased in the last two decades due to better neurosurgical techniques and neurocritical care and to advances in interventional neuroradiological procedures. We review the recent advances in the clinical and diagnostic aspects of SAH and in the genetics of intracranial aneurysms. A systematic review of the treatment of SAH and grading of the available evidence is included.

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“…Several factors can contribute to an increased risk in the parturient, including hormonal changes that aff ect cerebral vasculature. Additionally, pushing in the second stage of labor causes elevations in blood pressure (7). Preeclampsia and eclampsia increase the risk of onset emesis, increased urine output (2300 mL in 1 hour), and right-sided facial droop.…”

Section: Case Descriptionmentioning

confidence: 99%

Diagnosing and Managing Peripartum Headache

Grant

Wang

Gelpi

et al. 2015

Baylor University Medical Center Proceedings

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A 38-year-old gravida 7 para 5 Hispanic woman at 36 weeks and 4 days gestation presented with a postpartum headache following vaginal delivery complicated by an unintentional dural puncture for epidural analgesia. Due to the positional nature of the headache and its frontal and occipital origin, a postdural puncture headache was diagnosed. After failure of conservative treatment, an epidural blood patch was used, which offered immediate relief. However, shortly following the procedure, the parturient's neurological condition deteriorated due to an unrecognized intraparenchymal and subarachnoid hemorrhage requiring an emergent craniectomy. This case highlights the importance of diligence when evaluating and treating postpartum headache despite a classic presentation. F orty percent of postpartum women have headaches, most of which occur in the fi rst week. Most causes of postpartum headaches are relatively benign, including migraines and tension headaches. Studies have demonstrated that the weeks following childbirth, known as the puerperium, are a particularly vulnerable time period for development of headaches of a variety of primary and secondary headache disorders, mainly due to hormonal, physiological, procedural, and psychological factors (1). Th is case highlights that the diagnosis of postpartum headache should be evaluated carefully, and secondary causes, that are potentially life threatening, should fi rst be ruled out before diagnoses of common causes are postulated. CASE DESCRIPTIONA 38-year-old gravida 7 para 5 Hispanic woman at 36 weeks and 4 days gestation with no signifi cant past medical history requested epidural analgesia for pain relief during augmented labor. Th e fi rst attempt at epidural catheter placement was complicated by dural puncture with a 17-gauge epidural needle, confi rmed by free fl ow of cerebrospinal fl uid. Th e second attempt at epidural catheter placement was successful, and continuous lumbar epidural analgesia was achieved and remained eff ective throughout the uneventful vaginal delivery.On the second postpartum day, the patient began to complain of a frontal headache and a verbal pain score of 6 to 10/10 that worsened in the upright position. Th e patient was initially normotensive with no focal neurological defi cits, and

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Aneurysmal subarachnoid haemorrhage in pregnancy

Cited by 59 publications

References 90 publications

The management of intracranial aneurysms during pregnancy: a systematic review

The management of intracranial aneurysms during pregnancy: a systematic review

Update on subarachnoid haemorrhage

Diagnosing and Managing Peripartum Headache

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