The clinical characteristic and anesthesia management of cerebrovascular disease during pregnancy: a retrospective analysis

Abstract

Objective To investigate the clinical characteristic and anesthesia management in patients with pregnancy complicated with cerebrovascular disease. Methods We reviewed the clinical data, anesthesia management and outcome of pregnant women with cerebrovascular disease retrospectively from June 2010 to December 2017 in Beijing Tiantan Capital Medical University. Results A total of 30 cases of pregnant women with cerebrovascular disease were collected, including 5 cases of ischemic cerebrovascular disease: 3 cases of cerebral infarction, 2 cases of cerebral venous sinus thrombosis, 25 cases of hemorrhagic cerebrovascular disease, 4 cases of moyamoya, 1 case of preeclampsia, 4 cases of aneurysms, 13 cases of arteriovenous malformations, 3 cases of arteriovenous vascular malformation. Five cases underwent neurosurgery before cesarean section. Four cases of caesarean section during the same period of emergency neurosurgy, 6 cases of caesarean section after neurosurgery, and 15 cases of non-neurosurgical treatment after caesarean section. Thirty cases of obstetric anesthesia, including 3 cases in the second trimester and 27 cases in the second trimester, 16 cases of spinal anesthesia, 11 cases of general anesthesia. Two cases resulted in maternal death, 1 case resulted in fetal death. Conclusions The management of cerebrovascular diseases in pregnancy should be closely coordinated and managed by obstetrician, anesthesiologist and neurosurgeon. The patient's neurological symptoms, intracranial lesions (hematoma size, site), gestational age and fetal maturity, as well as the desire of pregnancy should be fully evaluated to timely terminate pregnancy and neurosurgical intervention and improve maternal fetal outcome. Key words: Pregnancy; Cerebrovascular disease; Anesthesia