[Cerebro-meningeal hemorrhage secondary to ruptured vascular malformation during pregnancy and post-partum].
Thirty two new cases of vascular malformations discovered during pregnancy were reviewed in a multicentric retrospective study and compared to the literature. The authors studied both the influence of pregnancy and post-partum on cerebral vascular malformations and the corresponding neurosurgical and obstetrical management. The relative frequencies of arteriovenous malformations (AVMs) and arterial aneurysms (AAs) is the same for pregnant and non-pregnant women. Pregnancy does not increase the risk of first bleeding of vascular malformations but the risk of re-bleeding is increased for AVMs. The bleeding of a vascular malformation is more strongly correlated to age than to parity. The mean maternal age at the time of rupture is greater for AAs than for AVMs, as it is in the general population. The bleeding of a vascular malformations occurs more frequently during the second and third trimesters of pregnancy than in the first one and in the post-partum. Labor and delivery are not great-risk-periods. Management of vascular malformation in pregnant woman is proposed as follow : --a ruptured AA or AVM is managed as it is in non-pregnant woman, whatever the gestational age; no fetal extraction needs to be performed except ed if the rupture occurs at the very end of the pregnancy;--an non-ruptured AVM discovered during pregnancy is treated after delivery; an non-ruptured AVM that never bled before pregnancy is managed in the same way that an non-ruptured AA.
Velut
S
S
Service de Neurochirurgie, CHU Bretonneau, 37044 Tours Cedex 01.
Vinikoff
L
L
Destrieux
C
C
Kakou
M
M
D017542:Aneurysm, Ruptured / Q000150:complications*; D020785:Central Nervous System Vascular Malformations / Q000150:complications*; D002543:Cerebral Hemorrhage / Q000209:etiology*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications*; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000209:etiology*; D011644:Puerperal Disorders / Q000209:etiology*; D012422:Rupture, Spontaneous