gms | German Medical Science

56. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
3èmes journées françaises de Neurochirurgie (SFNC)

Deutsche Gesellschaft für Neurochirurgie e. V.
Société Française de Neurochirurgie

07. bis 11.05.2005, Strasbourg

Aneurysmal subarachnoid hemorrhage in pregnancy: a challenging task

Aneurysmale Subarachnoidalblutung in der Schwangerschaft: eine herausfordernde Aufgabe

Meeting Abstract

  • corresponding author T. Martens - Klinik für Neurochirurgie, Universitätsklinikum Hamburg-Eppendorf
  • U. Kehler - Klinik für Neurochirurgie, Universitätsklinikum Hamburg-Eppendorf
  • M. Westphal - Klinik für Neurochirurgie, Universitätsklinikum Hamburg-Eppendorf
  • J. Gliemroth - Neurochirurgische Klinik, Universitätsklinikum Schleswig-Holstein, Campus Lübeck
  • J. Regelsberger - Klinik für Neurochirurgie, Universitätsklinikum Hamburg-Eppendorf

Deutsche Gesellschaft für Neurochirurgie. Société Française de Neurochirurgie. 56. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 3èmes journées françaises de Neurochirurgie (SFNC). Strasbourg, 07.-11.05.2005. Düsseldorf, Köln: German Medical Science; 2005. DocP075

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dgnc2005/05dgnc0343.shtml

Veröffentlicht: 4. Mai 2005

© 2005 Martens et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective

With improvements in antenatal care and management of deliveries, non-obstetric causes of maternal death became increasingly significant over the last decades. Although subarachnoid hemorrhage (SAH) rarely occurs during pregnancy, SAH due to cerebral aneurysmal rupture is the third leading cause of maternal mortality. Mortality rate is 13-35% for the mother and 7-25% for the fetus. We report on three cases indicating different management strategies.

Results

The first patient, 25 years old, suffered of SAH Hunt and Hess grade III in the 13th gestation week. In the 36th gestation week Cesarean section was followed by surgical clipping of superior cerebellary artery aneurysm in one-time anaesthesia. Middle cerebral artery aneurysm was diagnosed in another SAH patient in the 30th gestation week. Surgical clipping was performed under obstetric monitoring of the fetus on the same day of the hemorrhage and cesarean section was done in the 38th gestation week. Both women are now able to provide for their children after recovering. The third patient, 36th gestation week, had a SAH, Hunt and Hess grade IV. Misdiagnosis of eclampsia lead to emergent cesarean section before CT-imaging revealed massive SAH suspecting left middle cerebral artery aneurysm. The patient died prior to definite treatment of the aneurysm and due to recurrent SAH.

Conclusions

An interdisciplinary management is warranted in pregnant SAH patients where medical, obstetric and neurological complications reveal high mortality rates for the mother and the fetus. If the hemorrhage occurs at late time in pregnancy, Cesarean section saves fetus life and does allow occlusion of the aneurysm and aggressive SAH treatment. In high grade SAH patients recurrent bleedings have to be expected as well as secondary complications. Therefore urgent obstetric and neurosurgical treatment has to be performed at any time, reducing fatal outcome.