Intracranial hemorrhage due to aneurysms and arteriovenous malformations during pregnancy and puerperium

Introduction. Subarachnoid hemorrhage for aneurysms and arteriovenous malformations is most frequent during pregnancy and puerperium. We analyzed behavior and management of this patients and the effect on it of our Maternal Health Program. Patients and methods. There were 437 pregnancy and 717 puerperal complicated patients between january 1996 to december 2005, 41 maternal deaths of all causes and 14 indirect maternal deaths. There were operated on 454 patients with intracranial aneurysms and arteriovenous malformations in this period. Pregnant patients and fetus were evaluated to select mode of delivery. A specialized medical team managed precociously these patients. Vascular lesions were clipped by microsurgical methods. Anesthetic management considered pregnancy and fetal complexities. We did not use endovascular methods. Postoperative management was performed on intensive care unit. Results. There were eight pregnant and puerperal patients with subarachnoid hemorrhage due to aneurysms and arteriovenous malformations. 2% of all patients were operated on by this cause. Six harboured intracranial aneurysms and two arteriovenous malformations. We performed seven surgical procedures, five for aneurysms and two for malformations. There was a delivery rate of 2.1 and seven normal newborn. Four patients achieved a complete neurological recovery, two a partial recovery and there were two deceaseds. This cause constituted 14% of all indirect maternal deaths. Conclusion. A precocious clinical diagnosis, neuroimaging studies and interdisciplinary management that involve intensive therapy, obstetric attention and neurovascular surgical treatment determined an increment in the diagnosis of these lesions that require opportune microsurgical or endovascular treatment to prevent maternal death and fetal damage.