Repeat epidural caesarean section in a patient with cerebral arteriovenous malformation

Following a previous uneventful pregnancy and caesarean section, a 27-year-old woman with an untreated cerebral arteriovenous malformation presented again with a second pregnancy. While the cerebral haemodynamics during labour and delivery remain unclear, it is best to avoid Valsalva manoeuvres in women with cerebrovascular disease, and therefore caesarean section is usually the preferred method of delivery. The aim of anaesthetic management for caesarean section in women with cerebrovascular disease is the prevention of hypertension and increase in intracranial pressure. In the absence of decreased intracranial compliance, epidural anaesthesia is recommended because it avoids the haemodynamic stresses of laryngoscopy and rapid sequence intubation. The anaesthetic management of cerebral arteriovenous malformation in pregnancy is summarised.