Maternal and fetal treatment outcomes of pregnancy-related aneurysmal subarachnoid hemorrhage: a nationwide study.

Abstract

There is a paucity of data concerning the outcomes of aneurysmal subarachnoid hemorrhage (aSAH) in pregnant women. In this study, the authors investigated the clinical progression, treatment, and outcomes in women and their unborn children after aSAH during pregnancy. This nationwide retrospective population-based cohort study in Finland spans the years 1987-2016. The authors identified pregnant women diagnosed with aSAH through the Care Register for Health Care and Medical Birth Register (1,773,728 deliveries) and sudden prehospital deaths caused by aSAH from the Cause of Death Register. The authors reviewed medical records to delineate the clinical trajectories of each woman with aSAH. Twenty-eight pregnant women were hospitalized with aSAH between 1987 and 2016. In addition, 3 pregnant women died suddenly of aSAH at home or in the emergency department before hospitalization. Eight (29%) of the 28 hospitalized pregnant women were active smokers. The maximum mean aneurysm diameter was 7.1 (SD 4.2) mm. The aneurysm was surgically treated in 21 (75%) of the 28 women, endovascularly in 4 (14%), and by both methods in 3 (11%) patients. Most procedures (n = 23, 82%) were performed before childbirth. The most common method of delivery was emergency cesarean section (CS) (n = 13, 46%) followed by elective CS (n = 8, 29%). All infants of the hospitalized women survived. Vasospasm occurred in 5 (18%) and delayed cerebral ischemia in 3 (11%) women. There were no maternal or fetal deaths during hospitalization. The median modified Rankin Scale score at 3 months was 1 (IQR 0-2) for the hospitalized women. Two (7%) women received ventriculoperitoneal shunts for post-aSAH hydrocephalus. Aneurysmal SAH during pregnancy is associated with exceptionally low maternal and neonatal mortality. All maternal and fetal fatalities were due to sudden prehospital deaths. Pregnancy-related immunological modulation and its potential benefits on aSAH outcomes represent a compelling topic for future research.