Maternal and fetal outcomes in women with cerebrovascular malformations in pregnancy: A multicentre retrospective cohort study

• Published in: BJOG : an international journal of obstetrics and gynaecology 2022-06, Vol.129 (7), p.1151-1157
• Main Authors: Cauldwell, Matthew, Bredaki, Emma, Dassan, Pooja, Dhanjal, Mandish K., Kaler, Mandeep, Madipola, Nissanka, Mahmud, Mohammad, Paviour, Dominic, Senvar, Naz, Silva, Rajith, Watt‐Coote, Ingrid, Williams, David, Yulia, Angela, Steer, Philip J.
• Format: Article
• Language: English
• Subjects: arterial venous malformation; cavernomas; Cerebrovascular disease; Childbirth & labor; Clinical outcomes; Cohort analysis; Fetuses; Neonates; Neurological diseases; Pregnancy; Seizures; Vagina; Womens health
• ISSN: 1470-0328; 1471-0528
• DOI: 10.1111/1471-0528.17046

Objective To determine maternal, obstetric and neonatal outcomes in a cohort of women with cerebrovascular malformations (CVMs) that include arterial venous malformations (AVMs) and cavernomas. Design Retrospective cohort study. Setting Six specialist centres managing pregnant women with neurological disorders. Population Sixty‐three women with CVMs in 83 pregnancies of ≥20 completed weeks’ gestation. Methods Retrospective case notes review. Main outcome measures Neurological outcomes including rates of acute cerebral bleeding in pregnancy and reported seizures during pregnancy. Maternal outcomes included number of women with a livebirth and the proportion of women being delivered by caesarean section. Results Most women had a good pregnancy outcome with high rates of vaginal delivery (73%) at term. There were no maternal deaths. Six women had an acute cerebral bleed, all of whom were delivered by planned caesarean section. In total, ten women had seizures in pregnancy (of whom four also had a bleed). Six (7%) babies were admitted to a neonatal unit. There was no significant difference in outcomes between women with AVMs and those with cavernomas. Conclusion In the majority of cases, pregnancy outcomes were favourable, with most women having a vaginal delivery. All cases of cerebral bleeds that occurred were at a remove from the peripartum period. Tweetable Women with cerebrovascular malformations have high rates of vaginal delivery. Tweetable Women with cerebrovascular malformations have high rates of vaginal delivery.