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.