Objective: To determine maternal, obstetric and neonatal outcomes in a cohort of women with cerebrovascular malformations (CVMs) that include arterial venous malformations (AVMs) and cavernomas.Design: Retrospective cohort study.Setting: Six specialist centres managing pregnant women with neurological disorders.Population: Sixty-three women with CVMs in 83 pregnancies of ≥20 completed weeks' gestation.
Methods: Retrospective case notes review.Main outcome measures: Neurological outcomes including rates of acute cerebral bleeding in pregnancy and reported seizures during pregnancy. Maternal outcomes included number of women with a livebirth and the proportion of women being delivered by caesarean section. Results: Most women had a good pregnancy outcome with high rates of vaginal delivery (73%) at term. There were no maternal deaths. Six women had an acute cerebral bleed, all of whom were delivered by planned caesarean section. In total, ten women had seizures in pregnancy (of whom four also had a bleed). Six (7%) babies were admitted to a neonatal unit. There was no significant difference in outcomes between women with AVMs and those with cavernomas.
Conclusion:In the majority of cases, pregnancy outcomes were favourable, with most women having a vaginal delivery. All cases of cerebral bleeds that occurred were at a remove from the peripartum period.
Severe intra-uterine growth restriction (IUGR) is significantly associated with intra-uterine and perinatal morbidity and mortality. There are no reliable screening tools and currently, monitoring is with Doppler ultrasound after the diagnosis has been made. The vessels interrogated to decide optimal timing of delivery include the umbilical artery and middle cerebral artery, and ductus venosus which have significant limitations as predictive tools for perinatal outcome. Changes in fetal renal artery Dopplers may accurately reflect renal function which is vital to fetal wellbeing and amniotic fluid production. Fetal renal artery Dopplers may therefore be an important intermediary to screen for and predict fetal compromise prior to changes in other fetal blood vessels.
A Doppler blood flow examination is an integral part of the routine second trimester check to demonstrate fetal kidneys. This was extended to include measurements in the IUGR clinic in pregnancies prior to 23 completed weeks gestation. Correlation was sought with perinatal outcome measures including birth weight, Apgar scores, cord gases, requirement for resuscitation and NICU admission and comparisons against local normative charts. The results are presented
Conclusion
Potential was demonstrated for clinical use. Further research is needed.
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