Horton J C, Chambers W A, Lyons S L, Adams R D, Kjellberg R N
Department of Neurology and Neurosurgery, Massachusetts General Hospital, Boston.
Neurosurgery. 1990 Dec;27(6):867-71; discussion 871-2. doi: 10.1097/00006123-199012000-00002.
We conducted a retrospective analysis of 451 women with an arteriovenous malformation (AVM) of the brain to determine whether pregnancy is a risk factor for cerebral hemorrhages. A total of 540 pregnancies occurred among our patient population, resulting in 438 live births and 102 abortions. There were 17 pregnancies complicated by a cerebral hemorrhage. The hemorrhage rate during pregnancy for women with an unruptured AVM was 0.035 +/- 0.005 per person-year. The hemorrhage rate for nonpregnant women of childbearing age with an unruptured AVM was 0.031 +/- 0.002 per person-year. Pregnancy did not increase significantly the rate of first cerebral hemorrhage from an AVM (P = 0.35). We found that women with an AVM face a 3.5% risk of hemorrhage during pregnancy. Pregnancy is not a risk factor for hemorrhage in women without a previous hemorrhage. This conclusion assumes no selection bias exists in our study population; a bias would be introduced if the risk of fatal outcome after a hemorrhage were greater in pregnant women than in nonpregnant women.
我们对451例患有脑动静脉畸形（AVM）的女性进行了回顾性分析，以确定妊娠是否为脑出血的危险因素。我们的患者群体共发生了540次妊娠，其中438例活产，102例流产。有17次妊娠并发脑出血。未破裂AVM女性的妊娠期间出血率为每人年0.035±0.005。未破裂AVM的育龄非妊娠女性的出血率为每人年0.031±0.002。妊娠并未显著增加AVM首次脑出血的发生率（P = 0.35）。我们发现，患有AVM的女性在妊娠期间面临3.5%的出血风险。对于既往无出血的女性，妊娠不是出血的危险因素。本结论假定我们的研究人群不存在选择偏倚；如果出血后孕妇的致命结局风险高于非孕妇，则会引入偏倚。
