Ruptured intracranial aneurysm complicating pregnancy

Kriplani, Alka; Relan, Supriya; Misra, N. K.; Mehta, Veer Singh; Takkar, D.

doi:10.1016/0020-7292(94)02270-9

Cited by 39 publications

(54 citation statements)

References 5 publications

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“…Seventy-eight percent (n = 28) of ruptured aneurysms occurred during the third trimester, including two during labor; the remaining aneurysms ruptured during the first (8%) and second (11%) trimesters (22,27). None of the aneurysms included in this review ruptured during the postpartum period.…”

Section: Pregnancy Managementmentioning

confidence: 96%

“…Coil embolization was used more often than surgical clipping (56% vs 36%). Two untreated aneurysms ruptured during labor; one aneurysm was treated (surgical clipping) immediately after delivery while the other was monitored without surgery (22,27).…”

Section: Aneurysm Treatmentmentioning

confidence: 99%

“…The decrease in blood pressure that occurs during the second trimester is followed by a rise back to or above the patient's normal blood pressure range throughout the third trimester and postpartum period (28, delivery in patients with ruptured (87% vs 13%) and unruptured (71% vs 29%) aneurysms. All twelve patients who gave birth before receiving treatment for aneurysm rupture underwent Cesarean deliveries (10,13,22,23,27,32,38,40,42). Six of these were part of a combined neurosurgical-obstetrical approach in which treatment (clipping, n = 3; coiling, n = 3) immediately followed delivery (10,23,27,32,38,42).…”

Section: Risk Of Rupture During Pregnancymentioning

confidence: 99%

“…All twelve patients who gave birth before receiving treatment for aneurysm rupture underwent Cesarean deliveries (10,13,22,23,27,32,38,40,42). Six of these were part of a combined neurosurgical-obstetrical approach in which treatment (clipping, n = 3; coiling, n = 3) immediately followed delivery (10,23,27,32,38,42). Two additional patients with ruptured aneurysms underwent combined procedures in which treatment (surgical clipping) preceded Cesarean delivery (27,42).…”

Section: Risk Of Rupture During Pregnancymentioning

confidence: 99%

“…Five patients went into labor with previously untreated and unruptured aneurysms (14,22,27,42). Among these, one patient experienced aneurysm rupture during vaginal delivery and the child was immediately delivered via Cesarean section (27).…”

Section: Risk Of Rupture During Pregnancymentioning

confidence: 99%

See 4 more Smart Citations

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: Pregnancy Managementmentioning

confidence: 96%

Section: Aneurysm Treatmentmentioning

confidence: 99%