Pregnancy and the Risk of Hemorrhage from Cerebral Arteriovenous Malformations

Abstract

We conducted a retrospective analysis of 451 women with an arteriovenous malformation (AVM) of the brain to determine whether pregnancy is a risk factor for cerebral hemorrhages. A total of 540 pregnancies occurred among our patient population, resulting in 438 live births and 102 abortions. There were 17 pregnancies complicated by a cerebral hemorrhage. The hemorrhage rate during pregnancy for women with an unruptured AVM was 0.035 ±0.005 per person-year. The hemorrhage rate for nonpregnant women of childbearing age with an unruptured AVM was 0.031 ± 0.002 per person-year. Pregnancy did not increase significantly the rate of first cerebral hemorrhage from an AVM (P = 0.35). We found that women with an AVM face a 3.5% risk of hemorrhage during pregnancy. Pregnancy is not a risk factor for hemorrhage in women without a previous hemorrhage. This conclusion assumes no selection bias exists in our study population; a bias would be introduced if the risk of fatal outcome after a hemorrhage were greater in pregnant women than in nonpregnant women.

Abordagem anestésica de grávida com malformação arteriovenosa cerebral e hemorragia subaracnoidea durante a gravidez: relato de caso

“…On the other hand, Horton et al 9 in 1990, in a study of 451 women of childbearing age with AVM, concluded that pregnancy does not increase the risk of bleeding of an AVM, estimating it at 3.5% (risk of bleeding in the non pregnant female population of childbearing age, with an AVM, estimated at 3.1%). On the other hand, the risk of re-bleeding at one year after the fi rst bleeding during pregnancy in women whose AVM was not intervened immediately after the event, appears to be increased to 6%, compared to the risk of re-bleeding in non-pregnant population 3,9 .…”

“…There is controversy about the infl uence of pregnancy on natural history of AVM; however, the risk of fi rst rupture during pregnancy is 3.5%, which is similar to non-pregnant woman 9 . In these cases, treatment during pregnancy is based on neurological factors rather than obstetric indications 3 .…”

Anesthetic implications for the parturient with hereditary hemorrhagic telangiectasia

“…1,[25][26][27][28][29][30][31][32][33][34] It was initially thought that there was a significant risk of bleeding associated with rapid changes in cardiac output in any woman with CAVMs, for example, during the first trimester, labor, and delivery, but a retrospective analysis of 451 women found that the 3.5% risk of primary hemorrhage from a CAVM of any etiology during pregnancy did not differ significantly from the annual bleeding rate in a non-gravid patient. 29,31 No relationship with parity or trimester has been found. 35 In the event of any CAVM rupture during pregnancy, the risk of recurrent bleeding is unknown, but estimates have been as high as 27-30%, particularly during labor, delivery, and subsequent deliveries.…”

Hemorragia intracraniana na gravidez e puerpério: experiência com quinze casos

“…A relação entre MAV e HIC na gravidez é tema que gera controvérsia 11,23,[27][28][29] . Robinson et al, 23 analisando 24 casos, concluíram que uma mulher portadora de MAV teria 87% de chance de desenvolver HIC durante a gravidez.…”

“…Entretanto, Horton et al 27 , após analisarem minuciosamente a história clínica e evolução de 343 pacientes com MAVs que foram encaminhadas para tratamento radioterápico, concluíram que a gravidez não aumenta o risco de sangramento de uma MAV. Outros autores, também compartilham da opinião que a gestação não induz o sangramento de uma MAV 4,22,24,28,29 .…”