Ruptured Aneurysm during Pregnancy

Abstract

A case of surgically treated subarachnoid hemorrhage during pregnancy is reported. A 23-yearold woman at 22 weeks' gestation developed severe headache and frequent vomiting. On admission, she had mild confusion, disorientation, and moderate neck stiffness. Computed tomography scan of the head revealed subarachnoid hemorrhage. As a chest X-ray showed aspiration pneumonia, intentional delayed operation was selected. Cerebral angiography done on the 4th admission day disclosed a saccular aneurysm at the left internal carotid-posterior communicating junction. On the 12th admission day, at 24 weeks' gestation, craniotomy was carried out and clipping of the neck of the aneurysm was performed under gas-oxygen-fluothane general inhalation anesthesia. During the surgery, trinitroglycerin was administered in order to induce hypotension under continuous fetal heart rate (FHR) monitoring by cardiotocogram. Postoperative courses of the mother and fetus were uneventful, and the mother delivered a healthy female baby by a normal vaginal delivery when she was 38 weeks pregnant. FHR monitoring, which is feasible from 16 weeks' gestation, well represents the state of the fetus, and is useful for the surgical treatment of pregnant woman. Some consideration would be needed of probable teratogenicity induced by inhalation anesthetics such as halothane or nitrous oxide in patients before 16 weeks' gestation.