Document Detail


Cerebral Cavernous Malformations and Pregnancy: Hemorrhage Risk and Influence on Obstetrical Management.
MedLine Citation:
PMID:  22710379     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND:: Cerebral cavernous malformations are brain vascular malformations associated with intracranial hemorrhage. It is unclear if pregnancy is a risk factor for hemorrhage, yet there is speculation it may be. OBJECTIVE:: To compare the risk of clinically significant hemorrhage during pregnancy and non-pregnancy. METHODS:: 186 patients from the University of Toronto Vascular Malformations Study Group were enrolled. The obstetrical history of each patient was collected and matched to their neurological history from the records of the study group. All hemorrhagic events occurring during childbearing years were associated with either a defined pregnancy risk period or non-pregnancy period. Patients were also asked to recall advice they received from healthcare professionals regarding risk of hemorrhage in pregnancy. RESULTS:: Among our patient population there were 349 pregnancies (283 live births) and 49 hemorrhages during childbearing years, three of which were during pregnancy but none during delivery or within six week post-partum. The hemorrhage rate for pregnant women was 1.15% (0.23-3.35, 95% CI) per person-year and 1.01% (0.75-1.36, 95% CI) per person-year for non-pregnant women. Relative risk of pregnancy 1.13 (0.34 - 3.75, 95% CI), P = 0.84. Neurosurgeons and obstetricians were the source of most hemorrhage risk advice. The majority of neurosurgeons suggested that the risk was unchanged but the obstetricians were divided. Four patients never conceived and two others undertook contraception because of the advice they received. CONCLUSION:: The risk of intracranial hemorrhage from cerebral cavernous malformations is likely not changed during pregnancy, delivery, or post-partum.
Authors:
Christopher D Witiw; Amal Abou-Hamden; Abhaya V Kulkarni; Joseph A Silvaggio; Carol Schneider; M Christopher Wallace
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-6-15
Journal Detail:
Title:  Neurosurgery     Volume:  -     ISSN:  1524-4040     ISO Abbreviation:  -     Publication Date:  2012 Jun 
Date Detail:
Created Date:  2012-6-19     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7802914     Medline TA:  Neurosurgery     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
1School of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada 2Division of Neurosurgery, University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada 3Division of Neurosurgery, Hospital for Sick Children, Toronto, Ontario, Canada 4Section of Neurosurgery, Department of Surgery, Health Sciences Centre, University of Manitoba, Winnipeg, Manitoba, Canada 5Department of Obstetrics, Gynecology & Reproductive Sciences, University of Manitoba, Winnipeg, Manitoba, Canada 6Division of Neurosurgery, Department of Surgery, Queen's University, Kingston General Hospital, Kingston, Ontario, Canada.
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