title: Pre-existing, incidental and hemorrhagic AVMs in pregnancy and postpartum: Gestational age, morbidity and mortality, management and risk to the fetus.
abstract: OBJECTIVE
  The objective of this article is to analyze the maternal and fetal outcomes of pregnancies that present with arteriovenous malformations (AVMs).
  
  
  METHODS
  A literature review was performed that analyzed 65 cases of AVM during pregnancy previously reported in English literature.
  
  
  RESULTS
  Sixty-five cases of pregnancy-associated AVM were identified. The patients' ages ranged from 16 to 45 years, with a mean of 28 ± 4.9 years. Sixteen cases (24.6%) were pre-existing AVMs. There were 54 cases (83.1%) of AVM ruptured during pregnancy and postpartum: Six cases (11.1%) were in the first trimester, 24 (44.4%) were in the second, 22 (40.7%) were in the third trimester and two (3.7%) were postpartum. Unfavorable maternal clinical outcome (modified Rankin Scale (mRS) ≥ 2) was identified in 20 cases (30.8%) and abortion occurred in 10 cases (15.4%). There were three maternal deaths, yielding a case mortality rate of 4.6%. Fifty-three fetuses were born via cesarean section in 42 cases and vaginal delivery in 10 cases; 48 were in good health, three were temporarily intubated, one was macrosomic and one died. In univariate analysis, AVM hemorrhage presentation was significantly associated with a poor maternal outcome (mRS ≥ 2) (p = 0.030); however, not significantly associated with fetus risk (p = 0.864). Gestational age was not significantly associated with poor maternal outcome (p = 0.875) or fetal risk (p = 0.790).
  
  
  CONCLUSIONS
  AVM hemorrhage presentation was significantly associated with poor maternal outcome. Pre-existing ruptured AVM may not be associated with fetal risk. Gestational age of AVM rupture was not significantly associated with poor maternal outcome or fetal risk.
authors.affiliation: Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, China.
authors.forename: Xianli
authors.initials: X
authors.lastname: Lv
authors.affiliation: Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, China.
authors.forename: Peng
authors.initials: P
authors.lastname: Liu
authors.affiliation: Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, China lvxianli000@163.com.
authors.forename: Youxiang
authors.initials: Y
authors.lastname: Li
mesh_terms: D000293:Adolescent; D000328:Adult; D036861:Delivery, Obstetric; D005260:Female; D005313:Fetal Death / Q000209:etiology; D005315:Fetal Diseases / Q000209:etiology*; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D002538:Intracranial Arteriovenous Malformations / Q000150:complications / Q000453:epidemiology* / Q000401:mortality; D020300:Intracranial Hemorrhages / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D008875:Middle Aged; D049590:Postpartum Period; D064266:Preexisting Condition Coverage; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000453:epidemiology* / Q000401:mortality; D011256:Pregnancy Outcome; D012008:Recurrence; D012308:Risk Management; D055815:Young Adult
keywords: Arteriovenous malformation; postpartum; pregnancy