Management of pregnancy complicated with intracranial arteriovenous malformation

Katsuragi, Shinji; Yoshimatsu, Jun; Tanaka, Hiroaki; Tanaka, Kayo; Nii, Masafumi; Miyoshi, Takekazu; Neki, Reiko; Toyoda, Kazunori; Nagatsuka, Kazuyuki; Takahashi, Jun; Fukuda, Kenji; Hamano, Eika; Satow, Tetsu; Miyamoto, Susumu; Iihara, Koji; Ikeda, Tomoaki

doi:10.1111/jog.13585

Cited by 15 publications

(15 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Induction of labor is sometimes preferred in cases wherein the patient is receiving anticoagulation, to allow for better control. Unfractionated heparin and LMWH should be stopped 24h before labor induction and continued 24 h after birth, if no contraindications have developed (Katsuragi et al, 2018).…”

Section: Cerebrovascular Diseasementioning

confidence: 99%

Neuro-obstetrics: A multidisciplinary approach to care of women with neurologic disease

Brussé

Kluivers

Zambrano

et al. 2020

Handbook of Clinical Neurology

View full text Add to dashboard Cite

The term "neuro-obstetrics" refers to a multidisciplinary approach to the care of pregnant women with neurologic comorbidities, both preconceptionally and throughout pregnancy. General preconception care should be offered to all women, including women with neurologic disease. Women with neurologic comorbidities should also be offered specialist preconception care by an obstetrician who consults with a neurologist, anesthesiologist, and if indicated clinical geneticist and/or other specialists.In women with neurologic comorbidities, neurologic sequelae may influence the course of the pregnancy and delivery. Also, pregnancy may influence the severity of the neurologic condition, depending on the type of disease. Physiologic adaptations during pregnancy and altered pharmacokinetics may cause altered blood serum levels of drugs, leading to decreased or increased drug effects. When administering drugs to a woman who wishes to conceive, it is important to consider possible teratogenic effects and possible secretion in breast milk. Tailoring medication regimens should be considered, preferably preconceptionally. In this chapter, we review general principles of neuro-obstetric care, as well as some specific considerations for neurologists, obstetricians, and anesthesiologists caring for pregnant women with common neurologic conditions.

show abstract

Section: Cerebrovascular Diseasementioning

confidence: 99%

Neuro-obstetrics: A multidisciplinary approach to care of women with neurologic disease

Brussé

Kluivers

Zambrano

et al. 2020

Handbook of Clinical Neurology

View full text Add to dashboard Cite

show abstract

“…Multiple observational studies have demonstrated an increased risk of stroke during pregnancy and the postpartum period. However, comparison between studies is limited due to variability in definitions of stroke, categorization of timing (antepartum, peripartum, or postpartum), and study design (use of administrative data (5,6,12,13) versus registry-based (14)(15)(16) or institution-based (17)(18)(19)). While the pregnant state is widely thought of as high risk for stroke due to hypercoagulability and hemodynamic changes, the risk at time of delivery and during the puerperium appears far greater than the antepartum risk (20)(21)(22)(23).…”

Section: Epidemiology and Timing Of Maternal Strokementioning

confidence: 99%

“…Arteriovenous malformations.-Neurosurgical and/or endovascular treatment should be initiated as soon as AVM is identified as a cause of intracranial hemorrhage, due to the risk of rapid clinical deterioration. Cerebral angiogram and embolization with appropriate shielding are considered safe for the fetus (18). Strict blood pressure control during anesthesia is recommended, to avoid expansion of the hematoma while avoiding placental hypoperfusion (23).…”

Section: Management Of Hemorrhagic Stroke In Pregnancymentioning

confidence: 99%

“…Conservative management is usually recommended in the absence of intracranial hemorrhage, although some experts recommend preemptive treatment given the special risks of pregnancy (97). In patients with high-risk features including deep location and drainage, arteriovenous fistula, or concomitant aneurysm, the timing of any planned intervention should be decided on an individualized basis (18).…”

Section: Management Of Hemorrhagic Stroke In Pregnancymentioning

confidence: 99%

See 1 more Smart Citation

Maternal Stroke: an Update

Zambrano

Miller

2019

Curr Atheroscler Rep

View full text Add to dashboard Cite

Purpose of the review: Maternal morbidity and mortality is rising in the United States, and maternal stroke is a major contributor. Here, we review the epidemiology, risk factors and current recommendations for diagnosis and acute treatment of ischemic and hemorrhagic stroke during pregnancy and postpartum, focusing on recent evidence. Recent findings:The incidence of maternal stroke has risen in recent years, possibly due to increasing rates of hypertensive disorders of pregnancy. The risk of maternal stroke is highest in the peripartum and early postpartum period. Preeclampsia is highly associated with reversible cerebral vasoconstriction syndrome and posterior reversible encephalopathy syndrome, and is also associated with long-term increased risk of stroke and vascular dementia. Hypertensive disorders of pregnancy, migraine, and infections are risk factors for maternal stroke. Limited data suggest that thrombolytics and endovascular reperfusion therapy are safe and effective in pregnant women with ischemic stroke, but few data are available regarding safety of thrombolytics in the postpartum period. New consensus guidelines are now available to assist with management of ischemic and hemorrhagic stroke in pregnancy.Summary: Many gaps remain in our understanding of maternal stroke. While risk factors have been identified, there are no prediction tools to help identify which women might be at highest risk for postpartum stroke and require closer monitoring. The risk of recurrent maternal stroke has not been adequately quantified, limiting clinicians' ability to counsel patients. The complex pathophysiology of preeclampsia and its effects on the cerebral vasculature require further targeted study. An increased focus on the prevention, recognition, and optimal treatment of maternal stroke will be critical to reducing maternal morbidity and mortality.

show abstract

“…Dear Editor, We read the article by Shinji Katsuragi et al 1 with great interest and congratulate the authors on their review of cases and presentation of the data regarding the management of pregnancies complicated by intracranial arteriovenous malformation (AVM). However, we would like to add a few points.…”

mentioning

confidence: 99%

Letter to ‘Management of pregnancy complicated with intracranial arteriovenous malformation’

Kumari

Bhatia

2018

J of Obstet and Gynaecol

View full text Add to dashboard Cite

Management of pregnancy complicated with intracranial arteriovenous malformation

Cited by 15 publications

References 17 publications

Neuro-obstetrics: A multidisciplinary approach to care of women with neurologic disease

Neuro-obstetrics: A multidisciplinary approach to care of women with neurologic disease

Maternal Stroke: an Update

Letter to ‘Management of pregnancy complicated with intracranial arteriovenous malformation’

Contact Info

Product

Resources

About