Management of pregnancy complicated with intracranial arteriovenous malformation

Shinji Katsuragi, Jun Yoshimatsu, Hiroaki Tanaka, Kayo Tanaka, Masafumi Nii, Takekazu Miyoshi, Reiko Neki, Kazunori Toyoda, Kazuyuki Nagatsuka, Jun C. Takahashi, Kenji Fukuda, Eika Hamano, Tetsu Satow, Susumu Miyamoto, Koji Iihara, Tomoaki Ikeda

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Abstract

Aim: To clarify the perinatal outcomes in pregnancy complicated with intracranial arteriovenous malformation (i-AVM). Methods: A retrospective study was performed in 36 pregnancies complicated by i-AVM from 1981 to 2013 at one institution. Results: In total, 6 women miscarried, and 30 had live births. The median (range) gestational age at delivery was 38 (24–40) weeks; 11 cases experienced initial i-AVM rupture during pregnancy (first, second and third trimester: 18%, 64% and 18%, respectively). At onset, 4 cases had a Glasgow Coma Scale ≤10, 10 cases needed emergency maternal transport, 4 underwent neurosurgery with the fetus in utero and 4 had termination of pregnancy in the second trimester for emergent treatment for i-AVM. Two cases delivered vaginally. Another 25 cases had already been diagnosed as i-AVM at conception. Of these, as an indication for epidural birth, 18 cases had either residual lesion of i-AVM or neurological symptoms, although 18 cases had received treatments of i-AVM before conception. Without rupture of i-AVM and worsening of symptoms, 15 cases succeeded in epidural birth. One case was delivered by cesarean section for residual i-AVM with indication of treatment. Another case who had refused treatment of i-AVM experienced rupture of i-AVM 1 year after delivery. Conclusion: Most of the cases with residual i-AVM lesion and neurological symptoms could deliver vaginally without worsening of symptoms. However, pregnancy with i-AVM can be complicated by rupture of i-AVM. In cases with a residual lesion with indication of treatment and rupture of i-AVM during pregnancy, meticulous care is required during pregnancy and after delivery.

Original languageEnglish
Pages (from-to)673-680
Number of pages8
JournalJournal of Obstetrics and Gynaecology Research
Volume44
Issue number4
DOIs
Publication statusPublished - Apr 2018
Externally publishedYes

All Science Journal Classification (ASJC) codes

  • Obstetrics and Gynaecology

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  • Cite this

    Katsuragi, S., Yoshimatsu, J., Tanaka, H., Tanaka, K., Nii, M., Miyoshi, T., Neki, R., Toyoda, K., Nagatsuka, K., Takahashi, J. C., Fukuda, K., Hamano, E., Satow, T., Miyamoto, S., Iihara, K., & Ikeda, T. (2018). Management of pregnancy complicated with intracranial arteriovenous malformation. Journal of Obstetrics and Gynaecology Research, 44(4), 673-680. https://doi.org/10.1111/jog.13585