Vaginal cesarean section for second-trimester therapeutic abortion

Area of Science:

• Neurology
• Neurosurgery
• Obstetrics & Gynecology

Background:

• Brain arteriovenous malformations (AVMs) pose risks during pregnancy, particularly rebleeding after an initial hemorrhage.
• Spetzler-Martin Grade III AVMs in eloquent areas present complex management challenges during gestation.

Observation:

• A 30-year-old pregnant woman presented with symptoms of an intracerebral hemorrhage due to a Spetzler-Martin Grade III AVM.
• The patient underwent a second-trimester therapeutic abortion via vaginal cesarean section at 19 weeks of gestation.

Findings:

• Pregnancy itself does not elevate AVM bleeding risk, but a prior hemorrhage significantly increases the likelihood of rebleeding within the same pregnancy.
• Vaginal cesarean section provided a safe method for pregnancy termination in this case.

Implications:

• Termination of pregnancy via vaginal cesarean section is a potential management strategy for AVMs in eloquent brain areas presenting with hemorrhage during pregnancy.
• This approach offers an alternative to less favorable methods like dilatation and curettage or systemic abortifacients.