Aneurysmal Subarachnoid Haemorrhage in Pregnancy - case series, review and pooled data analysis

• Published in: World neurosurgery Vol. 88; pp. 383 - 398
• Main Authors: Robba, Chiara, Bacigaluppi, Susanna, Bragazzi, Nicola Luigi, Bilotta, Federico, Sekhon, Mypinder S, Bertuetti, Rita, Ercole, Ari, Bertuccio, Alessandro, Czosnyka, Marek, Matta, Basil
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.2016
• Subjects: Adult; Aneurysm, Ruptured; Cerebral aneurysm; Delivery; Female; Fetal Death - prevention & control; Humans; Maternal Death - statistics & numerical data; Neurosurgery; Pregnancy; Pregnancy Complications, Cardiovascular - diagnosis; Pregnancy Complications, Cardiovascular - mortality; Pregnancy Complications, Cardiovascular - therapy; Pregnancy Outcome - epidemiology; Prevalence; Risk Factors; Subarachnoid hemorrhage; Subarachnoid Hemorrhage - diagnosis; Subarachnoid Hemorrhage - mortality; Subarachnoid Hemorrhage - therapy; Young Adult; Internal Carotid Artery; Anterior Cerebral Artery; Not Available; Neurosciences Critical Care Unit; Caesarean Section; Middle Cerebral Artery; DSA; aSAH; Posterior Communicating Artery; Glasgow Coma Scale; cerebral aneurysm; PcomA; pregnancy; VA; Basilar Artery; PCA; Magnetic Resonance Imaging; PICA; NA; Digital Subtraction Angiography; MRA; BA; NCCU; Angiography; MRI; Anterior Communicating Artery; Standard Deviation; Syndrome of inappropriate antidiuretic hormone section; SD; Posterior Cerebral Artery; CSF; subarachnoid haemorrhage; Computed Tomography; chronic obstructive broncopulmonary disease; SIADH; ACA; AGF; delivery; Glasgow outcome Score; AcomA; Nationwide Inpatient Sample; CI; Cerebrospinal Fluid; Computed Tomographic Angiography; ICA; Magnetic Resonance Angiography; GOS; MCA; CS; Posterior Inferior Cerebellar Artery; CT; CTA; Confidence Interval; GCS; NIS; Vertebral Artery; aneurysmal subarachnoid haemorrage; COPD; Cerebral aneurysm; Subarachnoid hemorrhage; Pregnancy; Delivery
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2015.12.027

Abstract Background Aneurysmal subarachnoid haemorrhage (aSAH) during pregnancy represents an important cause of maternal and foetal morbidity and mortality. Approaches to diagnostics and treatment are still controversial and there are only a limited number of cases described in the literature. Our study examines the management of aSAH in pregnant patients creating a case series by combining patients from our hospital records with those from the limited available literature. Methods Data collected from Addenbrooke's Hospital records and cases published between January 1995 and January 2015 were studied. Chi-squared test, exact Fisher's test, and chi-squared test for trend were used for analyzing categorical data, whilst t-test and U Wilcoxon-Mann-Whitney test for continuous data. Results 52 patients were included. The mean age was 31.47±5.80 and most patients were in their third trimester. A univariate pooled data analysis suggested that the maternal outcome may depend on mother’s age, mother’s Hunt and Hess score and Glasgow Coma Scale at arrival, treatment modality for the aneurysm, mode and timing of delivery. However, at the multivariate analysis only the presence of general complications resulted to significantly impact on maternal outcome. Conclusions Ruptured aneurysms in pregnant patients with aSAH may be safely secured in a timely manner. The diagnostic and treatment strategy for each of these patients should consider peculiar maternal and obstetric factors and requires a multidisciplinary assessment involving obstetrics, neurosurgeons and intensivists. Considering the observed statistical power of our series, our findings should be taken with caution and should be supported by further systematic data collection.