Aneurysmal Subarachnoid Hemorrhage in Pregnancy—Case Series, Review, and Pooled Data Analysis

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• 作者：Chiara Robba<sup>1sup><sup> ; sup><sup>kiarobba@gmail.com" class="auth_mail" title="E-mail the corresponding authorsup> ; Susanna Bacigaluppi<sup>2sup> ; Nicola Luigi Bragazzi<sup>3sup> ; Federico Bilotta<sup>4sup> ; Mypinder S. Sekhon<sup>5sup> ; Rita Bertuetti<sup>1sup> ; Ari Ercole<sup>1sup> ; Alessandro Bertuccio<sup>6sup> ; Marek Czosnyka<sup>7sup> ; Basil Matta<sup>1sup>
• 关键词：Cerebral aneurysm ; Delivery ; Pregnancy ; Subarachnoid hemorrhage
• 刊名：World Neurosurgery
• 出版年：2016
• 出版时间：April 2016
• 年：2016
• 卷：88
• 期：Complete
• 页码：383-398
• 全文大小：18809 K

文摘

Aneurysmal subarachnoid hemorrhage (aSAH) during pregnancy represents an important cause of maternal and fetal morbidity and mortality. Approaches to diagnostics and treatment are still controversial, and there are only a limited number of cases described in the literature. Our study examines the management of aSAH in pregnant patients, creating a case series by combining patients from our hospital records with those from the limited available literature.

sSec_2">Methods

spara0015">Data collected from Addenbrooke's Hospital records and cases published between January 1995 and January 2015 were studied. Chi-square test, exact Fisher's test, and chi-square test for trend were used for analyzing categorical data, while the t-test and Mann-Whitney-Wilcoxon test were used for continuous data.

sSec_3">Results

spara0020">Fifty-two patients were included. The mean age was 31.47 &plusmn; 5.80, and most patients were in their third trimester. A univariate pooled data analysis suggested that the maternal outcome may depend on the mother's age, mother's Hunt and Hess scale score, Glasgow Coma Scale at arrival, treatment modality for the aneurysm, mode, and timing of delivery. However, at the multivariate analysis only the presence of general complications resulted in a significant impact on maternal outcome.

sSec_4">Conclusions

spara0025">Ruptured aneurysms in pregnant patients with aSAH may be safely secured in a timely manner. The diagnostic and treatment strategy for each of these patients should consider peculiar maternal and obstetric factors and requires a multidisciplinary assessment involving obstetrics, neurosurgeons, and intensivists. Considering the observed statistical power of our series, our findings should be taken with caution and should be supported by further systematic data collection.