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  • The risk of symptomatic hemorrhage during pregnancy in cerebral cavernous malformations

    Final Number:

    M. Yashar S. Kalani BS MS MD PhD; Joseph M. Zabramski MD

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2012 Annual Meeting

    Introduction: The risk of a symptomatic hemorrhage from a cerebral cavernous malformation(CCM) during pregnancy remains poorly defined. We undertook this study to better define the risk of pregnancy in this population.

    Methods: We examined the records of female patients with both sporadic and familial forms of CCM collected as a part of the Barrow CCM outcomes study. Clinical data related to pregnancy, including type of delivery and any change in neurological status, was collected from chart review and patient interviews.

    Results: We identified 168 pregnancies in 64 female CCM patients (28 sporadic and 36 familial). Assuming an average of 46 weeks per pregnancy (40 weeks gestation and 6 weeks puerperium), patients were at risk for a total of 7,728 weeks or 148.6 years. Symptomatic hemorrhage (defined as new onset/exacerbation, of seizure activity, or any change in neurologic status) occurred during 7 pregnancies, with the most common symptom being seizures (n=5). No patient required surgical intervention for a pregnancy related hemorrhage. The overall risk for symptomatic hemorrhage was 4.2% per pregnancy: 3.6% per pregnancy in the sporadic group, and 4.5% per pregnancy in the familial patients; however, the later group harbored an average of 4.8 lesions/patient. Vaginal delivery was performed without complications in 144 pregnancies. Two cesarean sections (8.3%) were performed in one familial CCM patient due to exacerbation of seizures.

    Conclusions: Our experience suggests that the risk of a symptomatic hemorrhage from a CCM during pregnancy is not increased, and that history of CCM is not a contraindication to pregnancy or vaginal delivery.

    Patient Care: It will help physicians understand the risk of a symptomatic hemorrhage from a cavernous malformation during pregnancy and will help guide treatment of these lesions.

    Learning Objectives: To understand the risk of hemorrhage from cavernous malformations during pregnancy.


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