Article
AVM haemorrhage in pregnant patients – use of multicentre databases for the quantitative assessment of rare diseases and treatment guidelines
AVM-Blutung bei schwangeren Patienten – Nutzen multizentrischer Datenbanken zur quantitativen Bewertung seltener Krankheiten und Behandlungsrichtlinien
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Published: | May 8, 2019 |
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Objective: Treatment of pregnant patients with AVM hemorrhage is challenging. However, data is also scarce. Because of the the rarity of this disease, standardized modalities in imaging and treatment algorithm are necessary in order to make individual treatment plans. The aim of the present study is to highlight the need for centralized databases to standardize treatment progression.
Methods: A retrospective study was performed in 79 female patients with ruptured AVMs, who were admitted to our neurosurgical department between 2002 and 2018. Only pregnant patients, who had an AVM hemorrhage during pregnancy were evaluated. We reviewed primary admission state (based on World Federation of Neurosurgical Societies: WFNS), AVM features, diagnostic and treatment algorithms and the final outcome at the last follow up.
Results: Three (3.8%) pregnant patients, who had an AVM hemorrhage before or during pregnancy were found. Mean age was 30 years. At onset, two patients (66.7%) had a WFNS grade III, and a Spetzler Martin Grade 4 AVM. One patient suffered an AVM hemorrhage in the 33+5 week of gestation and underwent an emergency cesarean section. Postpartum management was microsurgical hemorrhage evacuation and AVM resection with a favorable outcome.
Conclusion: AVM hemorrhage during pregnancy is rare and carries a high risk for the patient and the fetus. Treatment of pregnant patients with AVM hemorrhage is recommended in vascular neurosurgical departments. Central multicenter databases – e.g. built up and hosted by the DGNC and/or the vascular section - are useful for optimizing and standardizing the course of treatment. They can provide valid information for better treatment choices.