Trend Toward Vaginal Versus Cesarean Deliveries in Pregnant Patients with Unruptured Intracranial Aneurysms in the 2010s: A Nationwide Inpatient Analysis.

Abstract

The safety of spontaneous vaginal delivery in pregnant patients with known unruptured intracranial aneurysms (UIAs) has been supported by increasing evidence over the past 2 decades. However, the extent to which this increased evidence has since influenced changes, if any, in actual clinical practice, has yet to be studied. Using the 2012 to 2020 Nationwide Inpatient Sample, trends in vaginal versus caesarian delivery among mothers with UIAs were assessed in temporal fashion and compared to overall trends in delivery modality during the same period. Demographic, hospital, and insurance characteristics were also assessed for relationship with method of delivery. A total of 6,624,556 obstetrical patients presented for elective delivery in the 2012-2020 Nationwide Inpatient Sample. This included 419 patients with UIA included in the final analysis. Patients in later years were over twice as likely to have been given a trial of vaginal delivery (odds ratio: 2.01, 95% confidence interval: 1.29 to 3.14, P = 0.002). This was also statistically significantly different from overall rates of vaginal versus caesarian delivery in the overall cohort (P < 0.001). Hospital, regional, demographic and payer characteristics analyzed were not significantly associated with delivery method. There was a significant trend over the 2010s toward permitting more spontaneous vaginal deliveries for obstetrical patients with known UIAs.