RESUMO
Both the International Subarachnoid Aneurysm Trial (ISAT) and the International Study on Unruptured Intracranial Aneurysms (ISUIA) have been widely extrapolated to influence the management of actual or anticipated aneurysmal subarachnoid hemorrhage (SAH). However, it remains possible that sub-groups exist for which such extrapolation might subsequently prove premature. In this review, we discuss the implications that such extrapolation may potentially have for one such SAH sub-group: the clinically rare scenario of SAH in pregnancy.
Assuntos
Aneurisma Intracraniano/terapia , Complicações Cardiovasculares na Gravidez/terapia , Hemorragia Subaracnóidea/terapia , Adulto , Feminino , Humanos , Aneurisma Intracraniano/cirurgia , Gravidez , Complicações Cardiovasculares na Gravidez/cirurgia , Radiocirurgia , Hemorragia Subaracnóidea/cirurgiaAssuntos
Aneurisma Roto/terapia , Aneurisma Intracraniano/terapia , Complicações Cardiovasculares na Gravidez/terapia , Adulto , Aneurisma Roto/diagnóstico , Embolização Terapêutica/efeitos adversos , Feminino , Feto/efeitos da radiação , Idade Gestacional , Humanos , Aneurisma Intracraniano/diagnóstico , Gravidez , Complicações Cardiovasculares na Gravidez/diagnósticoRESUMO
Although uncommon, aneurysmal subarachnoid haemorrhage (SAH) in pregnancy can be devastating for both mother and baby. It is the leading cause of other indirect maternal death in England and Wales accounting for 60 deaths in the decade 1988-1999. No single obstetric or neurosurgical unit has sufficiently large database or experience in managing this condition in pregnancy. With significant improvements in antenatal care and management of deliveries, non-obstetric causes of maternal death such as aneurysmal subarachnoid haemorrhage are likely to become increasingly significant. The clinical features of aneurysmal subarachnoid haemorrhage closely resemble those of other commoner conditions seen in pregnancy. It is therefore imperative that awareness by obstetricians and other frontline staff is increased so that a high index of suspicion is maintained when pregnant women present with unique headaches. Prompt neurosurgical referral is vital and early involvement of an experienced neuroradiologist essential. It is only when an early diagnosis is made and an aggressive treatment instituted that the bleak case-fatality figure associated with aneurysmal subarachnoid haemorrhage in pregnancy can be improved. This review, by a multidisciplinary and multicenter team, provides a comprehensive update on the epidemiology, aetiology, clinical presentation, diagnosis and the complexities of the multidisciplinary management of this serious and potentially fatal condition when it occurs in pregnancy.