Cerebral cavernous malformation: Management and outcome during pregnancy and puerperium. A systematic review of literature

Merlino, Lucia; Prete, Federica Del; Titi, Luca; Piccioni, Maria Grazia

doi:10.1016/j.jogoh.2020.101927

Cited by 9 publications

(6 citation statements)

References 71 publications

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“…Although this is unlikely, conclusive data on this aspect can only be obtained from very large population‐based studies. However, our study is larger than many published reports which to tend to be single‐centre case series 21–23 and contains detailed information on pregnancy outcome, which is useful for counselling. In particular, we have demonstrated that vaginal delivery can safely be achieved in a large proportion of these patients.…”

Section: Discussionmentioning

confidence: 96%

Maternal and fetal outcomes in women with cerebrovascular malformations in pregnancy: A multicentre retrospective cohort study

Cauldwell

Bredaki²,

Dassan

et al. 2021

BJOG

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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.

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Section: Discussionmentioning

confidence: 96%

Maternal and fetal outcomes in women with cerebrovascular malformations in pregnancy: A multicentre retrospective cohort study

Cauldwell

Bredaki²,

Dassan

et al. 2021

BJOG

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“…The scientific literature is controversial regarding the course of CCMs in pregnancy. 4 According to older literature, pregnancy predisposes women to hemorrhage from CCMs, 2-6 while according to more recent studies the risk of intracranial hemorrhage remains almost unchanged during pregnancy. [7][8] The indications for neurosurgery in non-pregnant patients with CCM are the presence of seizures unresponsive to medical treatment, acute bleeding and re-bleeding.…”

Section: Discussionmentioning

confidence: 99%

“…The patient presented on CT an inhomogeneous area of altered density in the subcortical white matter of the left semioval center due to previous bleeding outcomes with modest peripheral edema from arteriovenous vascular malformation. Due to the progressive worsening of symptoms, in line with existing literature, 4‐5 neurosurgical intervention for CCM removal was planned.…”

Section: Casementioning

confidence: 96%

Hemorrhage of cerebral cavernous malformation in third trimester of pregnancy

et al. 2023

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Cerebral cavernous malformation is a rare but important cause of cerebral hemorrhage in pregnancy and puerperium. In pregnancy, cavernomas can more easily bleed as a result of increased female hormones and growth factors such as Vascular Endothelial Growth Factor. We present the case of a pregnant woman who had been diagnosed with a cerebral cavernoma about ten years previously, after repeated headache episodes; at the 28th weeks of pregnancy the woman was hospitalized for epileptic seizures and active bleeding from the anterior cerebral artery. We describe the management of the case, the decision for a preterm delivery and for a resolutive neurosurgical procedure.

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“…A recent study showed good long-term foetal and maternal outcomes [40 ▪ ]. Regarding cavernous malformations, increased bleeding risk in pregnancy is also debatable and, usually, the only indication for neurosurgery is the presence of rapidly progressive symptoms before 30 weeks of gestation; otherwise, postpartum management is advised [41 ▪ ].…”

Section: Haemorrhagic Strokementioning

confidence: 99%

Cerebrovascular disease in pregnancy and postpartum

Santos

Sousa

2021

Current Opinion in Neurology

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Purpose of reviewCerebrovascular disorders during pregnancy and puerperium are uncommon but potentially serious entities. This review aims to provide guidance on the diagnosis and management of these diseases, according to the most recent findings. Recent findingsProteinuria is no longer a mandatory criterion for the diagnosis of preeclampsia. Favourable long-term foetal and maternal outcomes are achieved in most patients with ruptured cerebral arterial malformations during pregnancy receiving interventional treatment prior to delivery. Despite the recent recommendations, physicians still hesitate to administer thrombolysis in pregnant women. In women with a history of cerebral venous thrombosis, prophylaxis with low molecular weight heparin during pregnancy and puerperium is associated with lower rates of recurrent thrombotic events and miscarriage.

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Cerebral cavernous malformation: Management and outcome during pregnancy and puerperium. A systematic review of literature

Cited by 9 publications

References 71 publications

Maternal and fetal outcomes in women with cerebrovascular malformations in pregnancy: A multicentre retrospective cohort study

Maternal and fetal outcomes in women with cerebrovascular malformations in pregnancy: A multicentre retrospective cohort study

Hemorrhage of cerebral cavernous malformation in third trimester of pregnancy

Cerebrovascular disease in pregnancy and postpartum

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