Division of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona 85013, USA.
J Neurosurg. 2013 Jan;118(1):50-5. doi: 10.3171/2012.8.JNS12241. Epub 2012 Oct 5.
The threat of symptomatic hemorrhage from cerebral cavernous malformations (CCMs) during pregnancy remains poorly understood. The authors undertook this study to better define the risk of pregnancy-related hemorrhage in this population.
The records of female patients with sporadic (isolated lesions and negative family history) and familial forms of CCM, which were collected as part of the Barrow Neurological Institute CCM natural history study, were examined. Clinical data related to pregnancy, including type of delivery (vaginal or cesarean section) and any change in neurological status, were obtained from chart reviews and patient interviews.
There were 168 pregnancies among 64 female patients with CCM (28 sporadic and 36 familial). Assuming an average of 46 weeks per pregnancy (40 weeks of gestation and 6 weeks of puerperium), patients were at risk for hemorrhage for a total of 148.6 years. Symptomatic hemorrhage (defined as new-onset or exacerbation of seizure activity or any change in neurological status) occurred during 5 pregnancies, with the most common symptom being seizures (4 cases). The overall risk for symptomatic hemorrhage was 3% per pregnancy; the risk was 1.8% per pregnancy in the sporadic group and 3.6% per pregnancy in the familial patients. There were 19 deliveries by cesarean section: 5 for obstetrical reasons, 8 for fear of possible hemorrhage, and 6 for unknown reasons. Vaginal delivery was performed without complications for the remaining 149 pregnancies.
The authors' experience suggests that the risk of symptomatic hemorrhage from a CCM during pregnancy is not increased and that a history of CCM is not a contraindication to pregnancy or vaginal delivery.
怀孕期间脑动静脉畸形（CCM）引起症状性出血的威胁仍未得到充分了解。作者进行这项研究是为了更好地定义该人群中与妊娠相关出血的风险。
作者检查了作为巴罗神经学研究所 CCM 自然史研究的一部分收集的散发性（孤立病变和阴性家族史）和家族性 CCM 女性患者的记录。从图表审查和患者访谈中获得了与妊娠相关的临床数据，包括分娩类型（阴道分娩或剖宫产）和任何神经状态的变化。
64 名 CCM 女性患者中有 168 例妊娠（28 例散发性和 36 例家族性）。假设每次妊娠平均 46 周（妊娠 40 周和产褥期 6 周），患者总共面临出血风险 148.6 年。5 例妊娠期间出现症状性出血（定义为新发或癫痫发作活动加重或任何神经状态变化），最常见的症状是癫痫发作（4 例）。总的症状性出血风险为每妊娠 3%；散发性组的风险为每妊娠 1.8%，家族性患者的风险为每妊娠 3.6%。有 19 例剖宫产分娩：5 例因产科原因，8 例因担心可能出血，6 例因不明原因。其余 149 例妊娠均行阴道分娩，无并发症。
作者的经验表明，CCM 在怀孕期间出现症状性出血的风险并未增加，并且 CCM 病史不是妊娠或阴道分娩的禁忌症。
