Cerebral arteriovenous malformation in pregnancy: Presentation and neurologic, obstetric, and ethical significance

Cerebral arteriovenous malformations infrequently complicate pregnancy. We sought to determine the neurologic, obstetric, and ethical significance of such malformations. We present the clinical course of 2 pregnant women with arteriovenous malformations who experienced cerebral hemorrhage and a loss of capacity for decision making. We also review the neurologic and obstetr ic significance of arteriovenous malformations in pregnancy. Various treatm ent options with concern for pregnancy and the prognosis for arteriovenous malformations are outlined. The ethical issues involved for pregnant patien ts whose decisional capacity is compromised as a result of cerebral injury are explored. A review of persistent vegetative state and brain death (deat h by neurologic criteria) occurring in pregnancy allows us to explore many issues that are applicable to decisionally incapacitated but physiologicall y functioning pregnant women. We outline a document, the purpose of which i s to obtain advance directives from pregnant women regarding end-of-life de cisions and to appoint a surrogate decision maker. We believe that evaluati on and treatment of the arteriovenous, malformation may be undertaken witho ut regard for the pregnancy and that the pregnancy should progress without concern for the arteriovenous malformation.