[Treatment of intracranial aneurysms during pregnancy]

Aneurysmal subarachnoid hemorrhage (SAH) during pregnancy is rare but serious obstetric complication. SAH occurs more often in primiparae and in the third trimester of pregnancy. The hemodynamic and endocrine changes play an important role in the growth and rupture of aneurysms. There are no differences in the clinical course of SAH among pregnant and non-pregnant patients. Subarachnoid hemorrhage during pregnancy may be confused with eclampsia. The confirmation of the diagnosis is made by computed tomography (CT) or lumbar puncture and cerebral angiography. Ruptured intracranial aneurysms should be treated as they would be in patients who are not pregnant. When the aneurysm is successfully clipped, the pregnancy can be allowed to progress to term. In these cases the vaginal delivery is preferred by most clinicians. Caesarean section would be indicated in several circumstances: when the clinical state of mother is severe (coma, brain stem damage), if the aneurysm is diagnosed at term of labour, if the interval between the neurosurgical treatment of aneurysm and labour is less than 8 days.