Abstract
Aneurysmal subarachnoid hemorrhage during pregnancy is rare but is thought to be important clinically, because it might become a cause of maternal mortality. SAH from an intracranial aneurysm that has ruptured during pregnancy poses a number of questions both with respect to treatment of the aneurysm and the management of delivery. Increasing interest in these questions prompted this review, which is based on a survey of the literature. We analyzed 5 experienced cases of ruptured aneurysms in pregnancy retrospectively. SAH from an aneurysm in the 5 cases occurred during the following weeks of pregnancy: 10 weeks, 1; 32-34 weeks, 4. Among the 5 patients, there were 5 ruptured aneurysms that arose from the following arteries: internal carotid, 2; middle cerebral, 2; anterior communicating, 1. Two patients underwent delivery of fetus by cesarean section followed by aneurysmal clipping. Three patients underwent aneurysm surgery prior to cesarean section. There was no significant morbidity or mortality in the mother and fetus except 1 case who was in severe condition because of SAH. One fetus was terminated medically because SAH occurred in the early stage of pregnancy. In general, pregnant patients with ruptured aneurysms should be treated in the same fashion as those who are not pregnant, and the aneurysm should be obliterated soon after diagnosis. But if the patient's neurological grading is poor, and if aneurysm surgery is determined to be too difficult, ruptured aneurysms should be treated after cesarean section.
