The Management of a Caesarean Section in a Patient with an Intracranial Arteriovenous Malformation

Laidler, J. A.; Jackson, Ian; Redfern, N.

doi:10.1097/00132582-198910000-00066

Cited by 7 publications

(10 citation statements)

References 1 publication

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“…In patients with AVM during pregnancy, problems during labor are related to the excessive cerebral hemodynamic changes, and cesarean section tends to be performed in these circumstances. 8) Cesarean section can be provided relatively safely, and is becoming more common. Recently, the rate of cesarean section has increased with the increase in high-risk pregnancies, such as with older maternal delivery age, and complicated pregnancies, which have increased up to 15% in a recent report from the Japanese Ministry of Health, Labour and Welfare.…”

Section: Delivery Managementmentioning

confidence: 99%

Pregnancy and Delivery Management in Patients With Cerebral Arteriovenous Malformation: A Single-Center Experience

Fukuda

Hamano

Nakajima

et al. 2013

Neurol. Med. Chir.(Tokyo)

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We described pregnancy and delivery management in 9 patients with cerebral arteriovenous malformation (AVM). Six patients presented with intracerebral hemorrhage (ICH) during pregnancy (first hemorrhagic episode); 2 patients presented with headache; and 1 patient with incidental detection of AVM. In the 3 patients with unruptured AVM, the diagnosis was made before pregnancy. In 3 of 6 patients who presented with ICH, AVM removal was performed during pregnancy. One patient required emergency surgery for the mass effect of the hematoma, and 2 patients with Spetzler-Martin grade I and II AVMs underwent elective surgery for the prevention of rebleeding. Radiosurgery for multiple AVMs was performed after delivery in one patient. Surgical resection and radiosurgery were performed after abortion in two patients. Of 3 patients with unruptured AVM, 2 patients became pregnant after radiosurgery and conservative treatment was initiated in 1 patient for Spetzler-Martin grade V AVM. Cesarean section was performed in 5 patients (one with severe uncontrollable pregnancy-induced hypertension) and vaginal delivery in 2 patients (one with grade V AVM). Delivery by obstetrical indication was possible in patients who underwent AVM resection during pregnancy. No rebleeding during pregnancy occurred. The maternal outcome was good except for the 2 patients with consequences of the initial ICH. The fetal outcome was good except for 2 cases of abortion. Pregnancy and delivery management in patients with AVM was successful in our institution. Early surgical intervention for AVM presenting as ICH during pregnancy could prevent rebleeding and improve the maternal and fetal prognosis.

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Section: Delivery Managementmentioning

confidence: 99%

Pregnancy and Delivery Management in Patients With Cerebral Arteriovenous Malformation: A Single-Center Experience

Fukuda

Hamano

Nakajima

et al. 2013

Neurol. Med. Chir.(Tokyo)

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“…30,47 In patients with high operative risk, inoperable lesions, or low-risk presenting in advanced pregnancy or labor, a conservative approach is taken with regard to the CAVM. Although there is a trend towards Cesarean delivery in these women, some reports claim that this affords no definite advantage over vaginal delivery.…”

Section: Respiratory Systemmentioning

confidence: 99%

“…25,[31][32][33][34][35]47 It is known that the rise in arterial pressure during a valsalva maneuvre is mirrored by an increase in cerebrospinal fluid (CSF) pressure. However, when released, CSF pressure decreases more quickly than arterial pressure, and this is thought to be the point where the AVM wall is potentially under the most stress.…”

Section: Respiratory Systemmentioning

confidence: 99%

“…50 The rationale behind the use of epidurals for operative delivery lies in the good quality analgesia both peri-and post-operatively, the avoidance of cardiovascular stresses, and the ability to monitor the neurological condition of the awake patient; however, attention to anti-emesis is mandatory to avoid unnecessary increases in intracranial pressure. 35,47 Yih reports the management of a 37-year-old non-HHT woman presenting at 32 weeks' gestation with a recurrent bleed from a previously ruptured CAVM. Using intravenous labetalol and sublingual nifedipine, a healthy female was delivered by Cesarean delivery under epidural anesthesia with both central venous and invasive arterial blood pressure monitoring.…”

Section: Respiratory Systemmentioning

confidence: 99%

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Anesthetic implications for the parturient with hereditary hemorrhagic telangiectasia

Lomax

Edgcombe

2009

Can J Anesth/J Can Anesth

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Purpose To review the effects of hereditary hemorrhagic telangiectasia (HHT) in the parturient and the anesthetic management of such patients during pregnancy and delivery. Source A literature search was performed using Medline and EMBASE databases. Bibliographies of retrieved articles were searched for additional sources. Principal findings Hereditary hemorrhagic telangiectasia affects 1 in 5000-8000 people. It is a genetic condition in which vascular dysplasia affects many organs particularly the pulmonary, cerebral, gastrointestinal, and spinal vasculature. A large proportion of women with HHT have uneventful pregnancies. However, women can present in pregnancy with clinically silent but potentially life-threatening features of the disorder including fatal hemorrhage from ruptured arteriovenous malformations (AVMs), systemic emboli, and high output cardiac failure secondary to arteriovenous shunting. Literature on the anesthetic management of HHT in pregnancy is limited. Both general and regional anesthetic techniques have been successfully performed in these patients, but are reliant on identifying the presence of specific AVMs; avoidance of cardiovascular instability; and prophylaxis against systemic emboli secondary to pulmonary AVM shunting. The presence of spinal AVMs is considered a relative contraindication to regional techniques. As with other systemic AVMs, these can develop and increase in size during pregnancy with implications for the timing of screening and surveillance. Conclusions An understanding of the presence and potential development of life-threatening AVMs during pregnancy is imperative for anesthesiologists caring for parturients with HHT. Even in the asymptomatic patient, a high index of suspicion should be maintained, screening performed where possible and anesthetic technique adapted accordingly. RésuméObjectif Passer en revue les effets de la te´langiectasie he´morragique he´re´ditaire (THH) chez les parturientes et la prise en charge de telles patientes pendant leur grossesse et l'accouchement. Source Une recherche de la litte´rature

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“…Anesthetic techniques during cesarean section in these patients should ensure precise hemodynamic control [8], but there are no definitive guidelines for these techniques because of the rarity of this condition. This is a report of successful administration of neuraxial anesthesia for emergency cesarean section in a case of ruptured maternal AVM.…”

mentioning

confidence: 99%

Anesthetic management during cesarean delivery in a pregnant woman with ruptured cerebral arteriovenous malformation -A case report-

Sim

Lee

et al. 2017

Anesth Pain Med

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Although intracranial hemorrhage from arteriovenous malformation (AVM) during pregnancy is rare, it can have fatal consequences. Anesthetic techniques for these patients should ensure precise hemodynamic control, and the goals of anesthesia should include both fetal and maternal well-being. We report a case of anesthetic management for cesarean section in a 31-year-old woman who presented at 32 weeks gestation with an acute intracranial hemorrhage secondary to rupture of a previously diagnosed AVM. Our medical team decided to perform emergent cesarean section under regional anesthesia before transferring the patient to the neurosurgical intensive care unit for further monitoring and appropriate postoperative pain control. The patient was alert and cooperative during neuraxial anesthesia. The operation was successful, and the patient showed gradual improvement in neurosurgical status after several days. We concluded that in case of emergency, regional anesthesia can be a safe strategy for cesarean section in a pregnant woman with symptomatic AVM. (Anesth Pain Med 2017; 12: 220-223)

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The Management of a Caesarean Section in a Patient with an Intracranial Arteriovenous Malformation

Abstract: The anaesthetic management of elective Caesarean section in a 25-year-old woman with an inoperable intracranial arteriovenous malformation is described. The literature is reviewed.

Cited by 7 publications

References 1 publication

Pregnancy and Delivery Management in Patients With Cerebral Arteriovenous Malformation: A Single-Center Experience

Pregnancy and Delivery Management in Patients With Cerebral Arteriovenous Malformation: A Single-Center Experience

Anesthetic implications for the parturient with hereditary hemorrhagic telangiectasia

Anesthetic management during cesarean delivery in a pregnant woman with ruptured cerebral arteriovenous malformation -A case report-

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