Intracraniële arterioveneuze malformaties tijdens zwangerschap

A desire to become pregnant in a patient with a
non-ruptured intracranial AVM is in itself not a reason
to treat the AVM. Although the risk of bleeding during
pregnancy is quite small, it is marginally increased in
pregnant women. Because the risk of rupture does
not appear to be increased during parturition, the
decision of spontaneous delivery or a caesarean
section can be taken on purely obstetric considerations.
When an intracranial AVM is first diagnosed during
pregnancy, it is nearly always after bleeding. A CT
angiography is the most appropriate examination in
order to identify a possible cause of the bleeding,
such as an intranidal aneurysm. After a haemorrhage,
treatment is aimed at preventing further neurological
deterioration in the mother, and individualized
based on the clinical picture of the pregnant
woman, and the characteristics of the AVM, with the intracereaim
of reaching a full term pregnancy. A decision to
perform urgent neurosurgical interventions is based
on general neurosurgical principles and does not deviate
from the considerations for non-pregnant women.
Both spinal and epidural anesthesia are safe options
for non-ruptured AVMs.