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Friday, April 3, 2015

Brain aneurysms in pregnancy

Pregnancy is a unique phase in a woman's life. It is associated with normal changes in almost every body system that assist fetal survival as well as preparation for labor. High blood pressure (hypertension) is the most common medical problem encountered during pregnancy and complicates 2%-3% of pregnancies. Diagnosis or rupture of a brain aneurysm during pregnancy poses serious life-threatening risk to the mother and the baby. It is therefore imperative that all Obstetricians are aware of this entity so that a high index of suspicion is maintained when pregnant women present with acute headache. The present article discusses some of the common questions about brain aneurysms in pregnancy.

Are brain aneurysms common in pregnancy?

Brain aneurysms rarely present during pregnancy.The reported incidence of brain aneurysm rupture during pregnancy ranges from 3-11 per 100,000 pregnancies. Of all the women presenting with ruptured brain aneurysm during pregnancy, 35% eventually die. It also results in death of the fetus in 17% of the cases. Although brain aneurysms are rare in pregnancy, they account for 5%-12% of all maternal deaths during pregnancy.

Is the risk of brain aneurysm rupture higher in pregnant women than in the general population?

It is unclear whether the risk of aneurysm rupture is higher in pregnant women than in general population. Many studies from Europe have reported increased risk of aneurysm rupture during pregnancy. However, a recent study from the United States reported no evidence of increased risk. The critical periods during pregnancy that can be detrimental to the mother and the fetus are labor and delivery.

How are brain aneurysms managed in pregnant women?

The management of brain aneurysms in pregnant women is similar to that in general population. Additional aspects that should be considered are

  • Asymptomatic unruptured intracranial aneurysm in pregnancy can be managed conservatively with close monitoring with noninvasive imaging techniques such as magnetic resonance imaging. However, expanding or symptomatic unruptured aneurysms in pregnant women should be treated

  • Radiation exposure to the fetus from CT scan and angiography should be minimized. MRI is the preferred imaging modality. If CT scan and angiography are absolutely required, a lead shield should be used to protect the fetus from radiation.

  • There are no evidence-based recommendations for child birth in patients with unruptured brain aneurysm, and there is no evidence to suggest that maternal or fetal outcome is improved by cesarean delivery in comparison with closely supervised vaginal delivery. Some studies have recommended caesarean delivery to avoid the stress of labor and delivery.

  • All women with ruptured brain aneurysms should be treated to prevent rebleeding. Clipping avoids the risk of radiation injury, but puts the mother and the fetus under stress during anesthesia and open surgery. Endovascular coiling poses radiation risk to the fetus.
  • 1 comment:

    1. Never heard of this, thanks for sharing have learnt something new

      ReplyDelete