Cerebral arteriovenous malformations during pregnancy: a management dilemma

Sohail, Rubina; Bashir, Qasim; Kanwal, Shahlla; Ali, Maryam Iqbal

doi:10.1136/bcr-2018-228759

Cited by 3 publications

(2 citation statements)

References 17 publications

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Section: Introductionmentioning

confidence: 99%

“…[ 3 ] Maternal physiological changes during pregnancy, such as increased cardiac output and elevated estrogen levels, can affect the structures of these blood vessels, thus making them more prone to rupture. [ 4 – 6 ] Although cAVM rupture and hemorrhage during pregnancy are rare (0.6–3.5%), [ 7 ] once these events occur, they can be fatal to pregnant women and fetuses. Studies have shown that severe AVM and aneurysm complications during pregnancy account for 5% to 12% of all maternal deaths and 17% of fetal mortality.…”

Section: Introductionmentioning

confidence: 99%

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Anaesthetic management of cerebral arteriovenous malformation hemorrhage during pregnancy: A case series

Liang

Liu

et al. 2023

Medicine

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Rationale: There is no clear consensus guidance for anesthesiologists on how to manage patients with cerebral arteriovenous malformation (cAVM) rupture and hemorrhage during pregnancy who need craniotomy. Our objective was to review the anesthesia management of pregnant women who underwent resection of cAVM at our institution and to provide opinions and suggestions. Patient concerns: Herein, we report of 3 patients with cAVM rupture and hemorrhage during pregnancy who underwent neurosurgery at the 22nd, 28th, and 20th weeks of pregnancy. Diagnoses: All 3 patients were admitted to the emergency department of our hospital due to sudden symptoms. Subsequently, their head imaging results confirmed the rupture and hemorrhage of cAVM. The rupture and hemorrhage of cAVM during pregnancy has a low incidence and high mortality, which seriously endangers the safety of the mother and fetus. For this emergency condition, craniotomy for removing intracranial lesions and clear hematoma can result in a chance of a successful delivery. Especially in the second and third trimesters of pregnancy, the management goal of anesthesia is to ensure the maternofetal safety and to maintain continuous pregnancy. Interventions: This article describes the process of intraoperative anesthesia management and maternal-fetal outcomes and discusses the key issues for the anesthesia management of cAVM rupture during pregnancy, including considerations of physiological changes during pregnancy and anesthesia medication, intraoperative monitoring, the maintenance of hemodynamic stability, and the control of intracranial pressure, among other considerations. Resection of intracranial lesions should be performed whenever possible while maintaining the pregnancy for better maternal and infant outcomes. Outcomes: The operations of the 3 pregnant women were successfully completed under our detailed anesthesia planning and careful anesthesia management. All the patients recovered well after the operation, and underwent cesarean section to give birth smoothly. Lessons: The preservation of pregnancy under cAVM resection is a complex challenge for anesthesiologists, and these 3 cases provide an extensive amount of experience for anesthesia management in similar situations. Detailed anesthesia planning and careful anesthesia management by anesthesiologists are important guarantees for good maternal and fetal outcomes.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Anaesthetic management of cerebral arteriovenous malformation hemorrhage during pregnancy: A case series

Liang

Liu

et al. 2023

Medicine

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Management of Acute Hemorrhage Caused by Cerebral Arteriovenous Malformation During Pregnancy–Case Series and Literature Review

Zhong

Jing-ci

et al. 2021

World Neurosurgery

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Embolization of Ruptured Infratentorial Pial AVM in Pregnancy

Zeleňák

Salát

Kolarovszki

et al. 2023

Life

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A primigravida 22-year-old woman, at a gestation of 23 weeks, experienced bleeding from a pial arteriovenous malformation (AVM) located in the right cerebellum. After interdisciplinary consensus and with the informed consent of the patient and her family, AVM embolization was performed. Complete occlusion of the AVM was achieved by embolization with PHIL (precipitating hydrophobic injectable liquid). The calculated dose in the uterus was less than 1 µSv, which represents a negligible risk of harmful effects on the fetus. She delivered a baby at 37 weeks of gestation by cesarean section without complications. No congenital disorders were diagnosed by standard screening methods until the age of the newborn was two years. The angiography protocol must be optimized to minimize the radiation dose. Adequate shielding protection of the uterus is important. Premature termination of pregnancy is not necessary. Multidisciplinary care of neurologists, neurosurgeons, interventional radiologists, anesthesiologists, neonatologists, and obstetricians is necessary.

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Cerebral arteriovenous malformations during pregnancy: a management dilemma

Cited by 3 publications

References 17 publications

Anaesthetic management of cerebral arteriovenous malformation hemorrhage during pregnancy: A case series

Anaesthetic management of cerebral arteriovenous malformation hemorrhage during pregnancy: A case series

Management of Acute Hemorrhage Caused by Cerebral Arteriovenous Malformation During Pregnancy–Case Series and Literature Review

Embolization of Ruptured Infratentorial Pial AVM in Pregnancy

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