Cerebral cavernous malformation: Management and outcome during pregnancy and puerperium. A systematic review of literature - 16/01/21

Doi : 10.1016/j.jogoh.2020.101927

Lucia Merlino ^a,^⁎ , Federica Del Prete ^a , Luca Titi ^b , Maria Grazia Piccioni ^a
^a Department of Maternal and Child Health and Urological Sciences, “Sapienza”, University of Rome, Policlinico Umberto I, Rome, Italy
^b Department of Anesthesiology, Critical Care and Pain, Section Obstetrical Care, “Sapienza”, University of Rome, Policlinico Umberto I, Rome, Italy

^⁎Corresponding author.

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Abstract

Introduction

Cerebral cavernomas malformations (CCMs) are vascular malformations that occur with an incidence of 0,4−0,8 % in general population. The most feared complication is cerebral hemorrhage. Currently there are no guidelines for pregnant women with CCMs. Some authors claimed that many physiological changes related to pregnancy could be linked to an high risk of rupture and bleeding of the cerebral cavernoma. However, more recent studies highlight that the presence of cerebral cavernomatosis is not a contraindication for pregnancy and that the risk of bleeding is similar in pregnant and in non-pregnant women.

Aim of the study

The purpose of our work is to analyze, through the study of controversial findings in literature, all the information currently available trying to establish a common approach for management of women with cerebral cavernomatosis in pregnancy, during childbirth and in the puerperium.

Findings

In accordance with existing literature, pregnancy does not appear to be a significant risk factor for the worsening of clinical manifestations associated with the presence of CCMs.

Vaginal delivery is not contraindicated in patients with CCMs and there is no indication to perform cesarean section to reduce the incidence of hemorrhage. The only indication for neurosurgery of CCMs in pregnancy is the presence of rapidly progressive symptoms and should be postponed to the puerperium if arises after 30 weeks. The puerperium is a critical time for the woman with cavernomas for the possibility of bleeding and clinical observation must be continued.

Conclusion

The patients with a diagnosis of a CCMs can have a pregnancy without any particular risk to themselves and the fetus but should be addressed to highly specialized obstetrics center to assesses the initial individual risk related to their pathology and to follow the pregnancy.

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Keywords : Cerebral cavernous malformations, Cavernous hemangioma, Pregnancy care, Delivery care, Hemorrhage in pregnancy, Obstetric outcomes