title: Vaginal cesarean section for second-trimester therapeutic abortion.
abstract: OBJECTIVE
  Pregnancy does not increase the risk of bleeding from a brain arteriovenous malformation (AVM), but once an AVM has bled during pregnancy, the rate of rebleeding during the same pregnancy is high. Therefore, termination of the pregnancy is an option for patients in whom the AVM is located in an eloquent area. We report a woman with an intracerebral hemorrhage from a brain AVM who underwent a second-trimester therapeutic abortion by vaginal cesarean section.
  
  
  METHODS
  A 30-year-old multiparous woman visited our emergency department at 17 weeks of gestation complaining of a sudden-onset headache with vomiting. She had no history of headaches or seizures. Based on the clinical presentation, computed tomography and magnetic resonance imaging, we made a clinical diagnosis of Spetzler-Martin Grade III AVM. Before undergoing stereotactic radiosurgery as a primary treatment, we advised her to terminate her pregnancy and performed a vaginal cesarean section at 19 weeks of gestation. Two months later, the patient underwent gamma knife surgery for the underlying lesion, without complications. Follow-up angiography and magnetic resonance imaging showed that the AVM had disappeared completely.
  
  
  CONCLUSIONS
  Although its indications are limited, vaginal cesarean section is a useful option for terminating a pregnancy that compensates for the disadvantages of dilatation and curettage and systemic abortifacients.
authors.affiliation: Department of Obstetrics and Gynecology, Kenwakai Otemachi Hospital, Fukuoka 803-0814, Japan.
authors.forename: Shinya
authors.initials: S
authors.lastname: Karakida
authors.affiliation: Department of Obstetrics and Gynecology, Kenwakai Otemachi Hospital, Fukuoka 803-0814, Japan.
authors.forename: Toshio
authors.initials: T
authors.lastname: Sasaki
authors.affiliation: Department of Obstetrics and Gynecology, Kenwakai Otemachi Hospital, Fukuoka 803-0814, Japan; Department of Obstetrics and Gynecology, Oita University Faculty of Medicine, Oita 879-5593, Japan. Electronic address: kenta9sp@oita-u.ac.jp.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Kai
authors.affiliation: Department of Neurosurgery, Kenwakai Otemachi Hospital, Fukuoka 803-0814, Japan.
authors.forename: Kei
authors.initials: K
authors.lastname: Harada
authors.affiliation: Department of Anesthesiology, Kenwakai Otemachi Hospital, Fukuoka 803-0814, Japan.
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Yoshimura
authors.affiliation: Department of Obstetrics and Gynecology, Kenwakai Otemachi Hospital, Fukuoka 803-0814, Japan.
authors.forename: Michiharu
authors.initials: M
authors.lastname: Kono
authors.affiliation: Department of Obstetrics and Gynecology, Oita University Faculty of Medicine, Oita 879-5593, Japan.
authors.forename: Hisashi
authors.initials: H
authors.lastname: Narahara
mesh_terms: D000032:Abortion, Therapeutic; D000328:Adult; D001165:Arteriovenous Malformations / Q000150:complications / Q000601:surgery*; D002543:Cerebral Hemorrhage / Q000209:etiology / Q000601:surgery*; D002585:Cesarean Section / Q000379:methods*; D005260:Female; D006801:Humans; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D016634:Radiosurgery; D014621:Vagina / Q000601:surgery
keywords: arteriovenous malformation; pregnancy termination; stereotactic radiosurgery; vaginal cesarean section; vaginal hysterotomy