Kirschen Gregory W, Brown Lucy, Davis Joy, Kim Dan, Berman David J, Al-Khindi Timour, Caplan Justin, Osborne Shannon M
Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, USA.
Anesthesiology, Johns Hopkins University School of Medicine, Baltimore, USA.
Cureus. 2024 Feb 8;16(2):e53822. doi: 10.7759/cureus.53822. eCollection 2024 Feb.
Cerebral aneurysms are rarely encountered in pregnancy. Their antepartum and intrapartum management remain clinically challenging, primarily due to concern regarding potential rupture. We present a case of a patient in preterm labor at risk for imminent delivery with a 10mm cerebral aneurysm. She was recommended for cesarean section (CS), yet delivered via spontaneous vaginal delivery in the operating room after induction of general anesthesia for the intended CS. Her aneurysm and neurologic function remained intact postpartum. Cerebral aneurysms <5mm are unlikely to undergo significant growth during pregnancy. The presence of a cerebral aneurysm is not automatically a contraindication to the Valsalva maneuver. The recommendation for which patients with unruptured cerebral aneurysms should deliver by CS, operative vaginal delivery, or unassisted vaginal delivery (i.e., which patients should avoid Valsalva maneuver intrapartum), is complex and requires multidisciplinary discussion.
颅内动脉瘤在孕期很少见。其产前和产时管理在临床上仍然具有挑战性，主要是因为担心有潜在破裂风险。我们报告一例早产且有即将分娩风险的患者，其患有一个10毫米的颅内动脉瘤。她原本被建议行剖宫产，但在为计划中的剖宫产实施全身麻醉诱导后，在手术室经阴道自然分娩。产后她的动脉瘤和神经功能保持完好。小于5毫米的颅内动脉瘤在孕期不太可能显著生长。存在颅内动脉瘤并非自动成为瓦尔萨尔瓦动作的禁忌证。对于哪些未破裂颅内动脉瘤患者应行剖宫产、阴道助产或经阴道自然分娩（即哪些患者应在产时避免瓦尔萨尔瓦动作）的建议很复杂，需要多学科讨论。
