Maternal arteriovenous malformation in pregnancy from presentation to birth: case report and literature review

Abstract

We describe the case of 37-year-old, gravida 9 para 4, she was 13 weeks and 4 days pregnant who had ruptured cerebral aneurysm adjacent to large frontal arteriovenous malformation causing intracranial haemorrhage. Underwent urgent craniotomy and repair. Medical and surgical therapy to maintain cerebral pressure. Multidisciplinary team meeting arranged for combined maternal and fetal wellbeing. Patient developed recurrent episodes of rising temperature and tachycardia with chorioamnionitis out-ruled. Final multidisciplinary meeting occurred at 31 weeks of pregnancy advised for elective cesarean section under general anaesthesia at 34 weeks, given ongoing urinary tack sepsis. Cesarean section performed, healthy 2.6 kg baby girl delivered, Minimal neonatal resuscitation required. This case showed good maternal and fetal outcome achieved as patient’s modified Rankin scale(mRS) (score measures the degree of disability or dependence in the daily activities of people who have suffered a stroke or other causes of neurological disability) improved from 5 to 4 and complete resolution of sepsis signs including tachycardia. Cooperation between neurosurgeons, obstetricians, neonatologist and anaesthesiologists and treatment strategy given to the patients are essential, guidelines for pregnant patients with cerebral arteriovenous malformation should be established.

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