Subarachnoid and cerebral hemorrhage secondary to ruptured vascular malformation during pregnancy and post-partum.

Thirty two new cases of vascular malformations discovered during pregnancy were reviewed in a multicentric retrospective study and compared to the lit erature. The authors studied both the influence of pregnancy and post-partu m on cerebral vascular malformations and the corresponding neurosurgical an d obstetrical management. The relative frequencies of arteriovenous malformations (AVMs) and arterial aneurysms (AAs) is the same for pregnant and non-pregnant women. Pregnancy does not increase the risk of first bleeding of vascular malformations bri t the risk of re-bleeding is increased for AVMs. The bleeding of a vascular malformation is more stuongly correlated to age than to parity. The mean m aternal age at the time of rupture is greater for AAs than for AVMs, as it is in the general population. The bleeding of a vascular malformations occu rs more frequently during the second and third trimesters of pregnancy than in the first one and in the post-partum. Labor and delivery are not great- risk-periods. Management of vascular malformation in pregnant woman is proposed as follow : a ruptured AA or AVM is managed as it is in nonpregnant woman, whatever the gestational age; no fetal extraction needs to be performed excepted if the rupture occurs at the very end of the pregnancy, the treatment of non-ruptured AAs depends of the gestational age; an non-ruptured AVM discovered during pregnancy is treated after delivery; an non-ruptured AVM that never bled before pregnancy is managed in the same way that an non-ruptured AA.