title: Aneurysmal Subarachnoid Hemorrhage in Pregnancy-Case Series, Review, and Pooled Data Analysis.
abstract: BACKGROUND
  Aneurysmal subarachnoid hemorrhage (aSAH) during pregnancy represents an important cause of maternal and fetal morbidity and mortality. Approaches to diagnostics and treatment are still controversial, and there are only a limited number of cases described in the literature. Our study examines the management of aSAH in pregnant patients, creating a case series by combining patients from our hospital records with those from the limited available literature.
  
  
  METHODS
  Data collected from Addenbrooke's Hospital records and cases published between January 1995 and January 2015 were studied. Chi-square test, exact Fisher's test, and chi-square test for trend were used for analyzing categorical data, while the t-test and Mann-Whitney-Wilcoxon test were used for continuous data.
  
  
  RESULTS
  Fifty-two patients were included. The mean age was 31.47 ± 5.80, and most patients were in their third trimester. A univariate pooled data analysis suggested that the maternal outcome may depend on the mother's age, mother's Hunt and Hess scale score, Glasgow Coma Scale at arrival, treatment modality for the aneurysm, mode, and timing of delivery. However, at the multivariate analysis only the presence of general complications resulted in a significant impact on maternal outcome.
  
  
  CONCLUSIONS
  Ruptured aneurysms in pregnant patients with aSAH may be safely secured in a timely manner. The diagnostic and treatment strategy for each of these patients should consider peculiar maternal and obstetric factors and requires a multidisciplinary assessment involving obstetrics, neurosurgeons, and intensivists. Considering the observed statistical power of our series, our findings should be taken with caution and should be supported by further systematic data collection.
authors.affiliation: Neurosciences Critical Care Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom. Electronic address: kiarobba@gmail.com.
authors.forename: Chiara
authors.initials: C
authors.lastname: Robba
authors.affiliation: Department of Neurosurgery, Galliera Hospital, University of Genova, Genova, Italy.
authors.forename: Susanna
authors.initials: S
authors.lastname: Bacigaluppi
authors.affiliation: Department of Health Sciences (DISSAL), University of Genova, Genova, Italy.
authors.forename: Nicola Luigi
authors.initials: NL
authors.lastname: Bragazzi
authors.affiliation: Department of Anaesthesiology, University of Rome "La Sapienza", Rome, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Bilotta
authors.affiliation: Department of Medicine, Division of Critical Care Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada.
authors.forename: Mypinder S
authors.initials: MS
authors.lastname: Sekhon
authors.affiliation: Neurosciences Critical Care Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom.
authors.forename: Rita
authors.initials: R
authors.lastname: Bertuetti
authors.affiliation: Neurosciences Critical Care Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom.
authors.forename: Ari
authors.initials: A
authors.lastname: Ercole
authors.affiliation: Department of Neurosurgery, St. George's Hospital, University of London, London, United Kingdom.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Bertuccio
authors.affiliation: Division of Neurosurgery, Brain Physics Laboratory, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom.
authors.forename: Marek
authors.initials: M
authors.lastname: Czosnyka
authors.affiliation: Neurosciences Critical Care Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom.
authors.forename: Basil
authors.initials: B
authors.lastname: Matta
mesh_terms: D000328:Adult; D017542:Aneurysm, Ruptured; D005260:Female; D005313:Fetal Death / Q000517:prevention & control; D006801:Humans; D063130:Maternal Death / Q000706:statistics & numerical data*; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D011256:Pregnancy Outcome / Q000453:epidemiology*; D015995:Prevalence; D012307:Risk Factors; D013345:Subarachnoid Hemorrhage / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D055815:Young Adult
keywords: Cerebral aneurysm; Delivery; Pregnancy; Subarachnoid hemorrhage