Pregnancy and delivery management in patients with cerebral arteriovenous malformation: a single-center experience

We described pregnancy and delivery management in 9 patients with cerebral arteriovenous malformation (AVM). Six patients presented with intracerebral hemorrhage (ICH) during pregnancy (first hemorrhagic episode); 2 patients presented with headache; and 1 patient with incidental detection of AVM. In the 3 patients with unruptured AVM, the diagnosis was made before pregnancy. In 3 of 6 patients who presented with ICH, AVM removal was performed during pregnancy. One patient required emergency surgery for the mass effect of the hematoma, and 2 patients with Spetzler-Martin grade I and II AVMs underwent elective surgery for the prevention of rebleeding. Radiosurgery for multiple AVMs was performed after delivery in one patient. Surgical resection and radiosurgery were performed after abortion in two patients. Of 3 patients with unruptured AVM, 2 patients became pregnant after radiosurgery and conservative treatment was initiated in 1 patient for Spetzler-Martin grade V AVM. Cesarean section was performed in 5 patients (one with severe uncontrollable pregnancy-induced hypertension) and vaginal delivery in 2 patients (one with grade V AVM). Delivery by obstetrical indication was possible in patients who underwent AVM resection during pregnancy. No rebleeding during pregnancy occurred. The maternal outcome was good except for the 2 patients with consequences of the initial ICH. The fetal outcome was good except for 2 cases of abortion. Pregnancy and delivery management in patients with AVM was successful in our institution. Early surgical intervention for AVM presenting as ICH during pregnancy could prevent rebleeding and improve the maternal and fetal prognosis.