Vaginal cesarean section for second-trimester therapeutic abortion

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 rebleecling 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. Case report: 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. Conclusion: 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. (C) Copyright 2013, Taiwan Association of Obstetrics & Gynecology. Published by Elsevier Taiwan LLC. All rights reserved.