title: Subarachnoid hemorrhage from intracranial aneurysms during pregnancy and the puerperium.
abstract: Subarachnoid hemorrhage (SAH) due to the rupture of an intracranial aneurysm (IA) is a rare but serious complication of pregnancy and is responsible for important morbidity and mortality during pregnancy. This study reviewed reports of ruptured IA during pregnancy and the puerperium, and our own cases of ruptured IA in pregnant women. Hemorrhage occurred predominantly during the third trimester of pregnancy, when maternal cardiac output and blood volume increase and reach maximum. Physiological and hormonal changes in pregnancy are likely to affect the risk of IA rupture. Ruptured IAs during pregnancy should be managed based on neurosurgical considerations, and the obstetrical management of women with ruptured IAs should be decided according to the severity of SAH and the gestational age. Emergent cesarean section followed by clipping or coiling of aneurysms is indicated if the maternal condition and the gestational age allow such interventions. Although SAH during pregnancy can result in disastrous outcomes, the necessity of intracranial screening for high-risk pregnant women is still controversial.
authors: Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan. hkataoka@ncvc.go.jp
authors: Hiroharu
authors: H
authors: Kataoka
authors: Takekazu
authors: T
authors: Miyoshi
authors: Reiko
authors: R
authors: Neki
authors: Jun
authors: J
authors: Yoshimatsu
authors: Hatsue
authors: H
authors: Ishibashi-Ueda
authors: Koji
authors: K
authors: Iihara
mesh_terms: D000328:Adult; D017542:Aneurysm, Ruptured / Q000175:diagnosis / Q000628:therapy*; D002585:Cesarean Section; D003299:Cooperative Behavior; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D033183:Interdisciplinary Communication; D002532:Intracranial Aneurysm / Q000175:diagnosis / Q000628:therapy*; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000175:diagnosis / Q000628:therapy*; D011263:Pregnancy Trimester, Third; D011644:Puerperal Disorders / Q000175:diagnosis / Q000628:therapy*; D012307:Risk Factors; D013345:Subarachnoid Hemorrhage / Q000175:diagnosis / Q000628:therapy*; D013525:Surgical Instruments; D055815:Young Adult