Abstract TP581: Maternal and Fetal Outcomes in Women With Brain Arteriovenous Malformation Rupture During Pregnancy

Abstract

Background: Intracranial hemorrhage (ICH) is often the initial presenting symptom for patients with brain arteriovenous malformations (bAVM), which is further complicated in the setting of pregnancy. There are no standard guidelines for management of pregnant women with bAVM, and few studies have reported on maternal and fetal outcomes in those with bAVM ICH. The purpose of this descriptive study was to review our case series for maternal and fetal outcomes in women with bAVM ICH during pregnancy. Methods: We conducted a retrospective review of our database for women between the ages of 15-50 years who presented with a bAVM ICH during pregnancy between 2000-2017. Demographics, angiographic characteristics, gestational age/trimester at ICH, mode and timing of AVM treatment, and maternal (e.g. modified Rankin Scale, mRS) and fetal outcomes (e.g. healthy or intrauterine fetal death) were recorded from the medical records. Results: We identified 16 bAVM cases who were pregnant at the time of ICH. Mean age of cases was 27±6.7 years, 56% were non-Caucasian, and 81% presented with an ICH during the second or third trimester. Of 16 patients, 2 terminated pregnancies in the 1 st trimester, 1 miscarried immediately after ICH, and 13 patients carried to term (69% delivered cesarean and 23% vaginal). Of 13 patients with live births, 77% received emergent AVM treatment (embolization+resection or resection only) at time of ICH, while 3 deferred treatment until after birth. The majority of bAVMs were Spetzler-Martin grade 2 or 3 (87%), 56% had deep venous drainage, and mean AVM size was 2.5±1.2cm. At 2-year follow-up, 85% of women had good outcomes (mRS 0-2). Only one patient did worse after AVM treatment due to a permanent neurological deficit. All cases had healthy fetal outcomes at time of delivery and at 2-yr follow-up. Conclusion: Our case series suggest good fetal and maternal outcomes in ruptured bAVM patients presenting during pregnancy, the majority of which were treated before delivery. Treatment of ruptured AVMs during pregnancy should be tailored to the needs of each specific patient in close consultation with the obstetrics and neurosurgery teams.