Uneventful delivery with caesarean section in a woman with a history of endovascular management of an intracranial aneurysm

Mavromatidis, Georgios; Dinas, Konstantinos; Mamopoulos, Apostolos; Delkos, D.; Vosnakis, Christos; Michailidis, Kleopas; Rousso, David

doi:10.3109/01443615.2011.603770

Cited by 4 publications

(3 citation statements)

References 10 publications

(23 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Selecting a strategy for the treatment of intracranial aneurysms is challenging, and balancing the risks to the fetus and mother adds further complexity (10,12,30). However, guidelines for the management of intracranial aneurysms during pregnancy are not currently available.…”

Section: █ Discussionmentioning

confidence: 99%

“…Vaginal delivery was deemed inappropriate by some studies because of the associated methods of anesthesia delivery, high-pressure Valsalva maneuvers needed by the patient, or existing aneurysm-related complications such as cranial defects from prior clipping (16,30). Lumbar puncture involved with spinal and epidural anesthesia (both commonly used for vaginal delivery) has been reported to increase the risk of aneurysm rupture due to loss of CSF and increased vessel transmural pressure (3,8).…”

Section: Methods Of Child Deliverymentioning

confidence: 99%

See 1 more Smart Citation

The management of intracranial aneurysms during pregnancy: a systematic review

Barbarite

Hussain

Dellarole

et al. 2015

Turkish Neurosurgery

View full text Add to dashboard Cite

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...

show abstract

Section: █ Discussionmentioning

confidence: 99%

Section: Methods Of Child Deliverymentioning

confidence: 99%

The management of intracranial aneurysms during pregnancy: a systematic review

Barbarite

Hussain

Dellarole

et al. 2015

Turkish Neurosurgery

View full text Add to dashboard Cite

show abstract

“…Investigations regarding fetal mortality rate showed it to be lower (5 %) among the surgically treated group than those who were managed conservatively (27 %) [9]. Mavromatidis et al suggest clipping as the most reasonable way to treat ruptured aneurysms even in pregnant women or patients of reproductive age to avoid the higher risk of re-bleeding in case of prior endovascularly treated intracranial aneurysm [32][33][34]. If the aneurysm is successfully clipped, the pregnancy can be allowed to progress to term [35].…”

Section: Discussionmentioning

confidence: 99%

Maternal Aneurysmal Subarachnoid Hemorrhage During Pregnancy as an Interdisciplinary Task

Fritzsche

Regelsberger

Schmidt

et al. 2017

Z Geburtshilfe Neonatol

View full text Add to dashboard Cite

Maternal aneurysmal subarachnoid hemorrhage (aSAH) during pregnancy presents a challenge regarding treatment and management. Due to the limited number of cases there are no treatment guidelines available. Thus, treatment is usually done on a case-by-case basis. Here we report on four cases of aSAH during pregnancy, describing the different management strategies and suggesting a possible treatment algorithm. Patients treated between 2003 and 2013 in our center were included in this retrospective study. Clinical data focused on time management concerning gestation week (GW), microsurgical or endovascular treatment, and outcome of the patients and the fetuses. Results were compared to the present literature on this issue. Mean age was 30.8 years, initial Hunt & Hess (H&H) grade ranged from III to V. All patients suffered from aSAH during the 3rd trimester of pregnancy. In the four cases, two emergency Caesarean sections (CS) were performed. Two aneurysms were occluded by microsurgical clipping and one was treated endovascularly. One patient died before definitive treatment of the aneurysm could be achieved, whereas fetal mortality was 0%. The mean follow-up was 83 months. aSAH during pregnancy needs individualized interdisciplinary management. Efforts must focus on the mother so that a delay in the best available treatment for the pregnant patient is avoided. Therefore treatment modality should be primarily determined by the aneurysm itself. However, timing in terms of delivery of the fetus and aneurysm treatment is a crucial point.

show abstract