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[Cerebral aneurysms and pregnancy: 4 cases].
S Depret-Mosser1, J C Monnier, A S Bouthors-Ducloy
1Service de Gynécologie-Obstétrique, Maternité du Pavillon Victor-Olivier, CHU, Lille.
Summary
Pregnancy increases the risk of cerebral aneurysms rupturing, leading to haemorrhagic cerebral accidents, particularly in first-time mothers during the third trimester. Prompt neurosurgical intervention is crucial to prevent recurrent bleeding and ischaemia.
Area of Science:
- Neurosurgery
- Obstetrics
- Vascular Neurology
Background:
- Haemorrhagic cerebral accidents are the most frequent neurosurgical conditions during pregnancy.
- Pregnancy elevates the risk of arterial or arteriovenous aneurysm rupture, the primary cause of these haemorrhages.
- These events predominantly affect primiparae in the third trimester.
Observation:
- Diagnosis is confirmed through scanning and angiography.
- Eclampsia is the primary differential diagnosis.
- Immediate neurosurgical treatment is recommended to mitigate risks of re-bleeding and ischaemia.
Findings:
- Caesarean section is indicated only in specific severe maternal conditions or when the fetus is viable and the vascular malformation poses significant risks.
- Vaginal delivery is generally preferred under epidural anaesthesia, especially if medical induction or instrumental delivery is necessary.
- Prognosis is often poor, contingent upon the initial neurosurgical severity, lesion etiology, and treatment efficacy.
Implications:
- Optimal management necessitates a multidisciplinary approach involving neurosurgical and obstetric teams.
- Timely intervention can improve outcomes for both mother and child in cases of pregnancy-related cerebral haemorrhage.
- Further research into preventative strategies and refined treatment protocols for pregnant patients with cerebral vascular abnormalities is warranted.