ISSN 2415-3060 (print), ISSN 2522-4972 (online)
  • 12 of 58
Up
JMBS 2020, 5(6): 88–94
https://doi.org/10.26693/jmbs05.06.088
Clinical Medicine

Clinical Case of Arteriovenous Malformation in a Pregnant Woman

Abdullaeva N. A., Cherepova V. I., Tovazhnyanska O. L., Lazurenko V. V.
Abstract

Extragenital pathology during pregnancy and childbirth occupies a leading place in maternal mortality and perinatal pathology. One of the main ways to maintain the health of mother and child is to identify somatic diseases in pregnant women and timely treat them. Nervous system diseases that occur in pregnant women are mainly epilepsy, multiple sclerosis, brain tumors, cerebrovascular disorders, although remain poorly understood, but require immediate decisions to prolong pregnancy, obstetric tactics during childbirth, conservative or conservative surgery. The pathology of cerebral vessels (arterial aneurysms and arteriovenous malformations) also remains an urgent problem, despite many years of experience in their diagnosis and treatment. The sudden development of symptoms, severity of clinical manifestations and high mortality in rupture of an aneurysm or arteriovenous malformation of cerebral vessels determine the urgency of this problem and increased interest in its study, especially in pregnant women. Material and methods. The paper presents a clinical case of arteriovenous malformation in a 25-year-old pregnant woman, her treatment and delivery. Results and discussion. Arteriovenous malformation is considered a congenital cerebrovascular pathology, which is accompanied by a sudden rupture of abnormal vessels with the development of hemorrhagic stroke, without specific clinical symptoms and precursors, which complicates lifelong diagnosis. Endovascular embolization during pregnancy saved the lives of women and children. An effective result was obtained after neurosurgical treatment of arteriovenous malformation in a pregnant woman in the second trimester of pregnancy (17 weeks), which allowed to bring the pregnancy to the physiological time of delivery. Taking into account the complex neurological pathology, neurosurgery, which requires the exclusion of a powerful period of childbirth, a pregnant woman gave birth by cesarean section at 38 weeks of pregnancy. Conclusion. An effective result was obtained after neurosurgical treatment of arteriovenous malformation in a pregnant woman in the second trimester of pregnancy, which allowed to bring the pregnancy to the physiological time of delivery. The obtained results indicated the possibility of full-term pregnancy, reduction of maternal and perinatal morbidity and mortality in pregnant women with arteriovenous malformation with timely preventive and curative measures with timely referral of pregnant women to the perinatal center on the basis of a multidisciplinary clinical institution to prevent complications

Keywords: pregnancy, arteriovenous malformation, aneurysms, hemorrhage, endovascular embolization

Full text: PDF (Ukr) 316K

References
  1. Barbarite E, Hussain S, Dellarole A. The Management of Intracranial Aneurysms During Pregnancy: A Systematic Review. Turk Neurosurg. 2016; 7: 13-23. https://doi.org/10.5137/1019-5149.JTN.15773-15.0
  2. Dzyak LA. Sosudystye malformatsyy golovnogo mozga [Vascular malformations of the brain]. Zdorov’ya Ukrayiny. 2008;12 (1): 1-14. [Russian]
  3. Mekhedko VV. Vagitnist ta arterialni anevryzmy i arteriovenozni malformatsiyi sudyn golovnogo mozku [Pregnancy and arterial aneurysms and arteriovenous malformations of cerebral vessels]. Biomedical and biosocial anthropology. 2014; 23: 284-290. [Ukranian]
  4. Liu XJ, Wang S, Zhao YL, Teo M, Guo P, Zhang D, et al. Risk of cerebral arteriovenous malformation rupture during pregnancy and puerperium. Journal of Neurology. 2014; 82(20):1798-1803. https://doi.org/10.1212/WNL.0000000000000436
  5. Arustamyan RR, Adamyan LV, Shyfman EV, Ovezov A.M. Ostrye narushenyya mozgovogo krovoobrashchenyya vo vremya beremennosty, rodov y poslerodovom peryode [Acute disorders of cerebral circulation during pregnancy, childbirth and the postpartum period]. Almanakh klynycheskoy medytsyny. 2016; 44(3): 295-300. [Russian] https://doi.org/10.18786/2072-0505-2016-44-3-295-300
  6. Falion RI, Kuzyk YuI, Kovalyk OYa. Arteriovenozni malformatsiyi golovnogo mozku v dytyachomu vitsi: analiz letalnogo vypadku [Arteriovenous malformations of the brain in childhood: a lethal analysis]. Problema klinichnoyi pediatriyi. 2015; 3(29): 22-26.
  7. Bobronok VG, Yatsyk VA, Yasynska NV, Kuzyk YuI. Arteriovenozni malformatsiyi golovnogo mozku: analiz avtopsiy [Arteriovenous malformations of the brain: autopsy analysis]. Praktychna angiologiya. 2010; 5(6): 34-35. [Ukranian]
  8. Goncharuk OM, Babkina TM. Arteriovenozni malformatsiyi ta anevryzmy golovnogo mozku. Klinichni proyavy ta metody suchasnoyi promenevoyi diagnostyky [Arteriovenous malformations and brain aneurysms. Clinical manifestations and methods of modern radiological diagnostics]. Promeneva diagnostyka, promeneva terapiya. 2010; 1: 50-54. [Ukranian]
  9. Shcheglov DV, Bortnyk IM, Svyrydyuk OYe, Konotopchyk SV, Pastushyn OA. Dynamichne sposterezhennya za anevryzmamy pislya embolizatsiyi arteriovenoznykh malformatsiy golovnogo mozku [Dynamic observation of aneurysms after embolization of arteriovenous malformations of the brain]. Endovaskulyarna neyrorentgenokhirurgiya. 2015; 3(13): 70-76. [Ukranian]
  10. Xianli L, Peng L, Youxiang L. Pre-existing, incidental and hemorrhagic AVMs in pregnancy and postpartum: Gestational age, morbidity and mortality, management and risk to the fetus. Journal of Interventional Neuroradiology. 2016; 22 (2): 206-211. https://doi.org/10.1177/1591019915622161
  11. Altman IV. Problema uskladnen ta retsydyvi pry likuvanni arteriovenoznykh malformatsiy golovnogo mozku. Poglyad na problemu z tochky zoru teoriyi neoangiogenezu. Novi mozhlyvosti likuvannya [The problem of complications and recurrences in the treatment of arteriovenous malformations of the brain. A look at the problem in terms of the theory of neoangiogenesis. New treatment options]. V: Zb nauk prats spivrobit NMAPO imeni PL Shupyka. 2017; 28: 227-235. [Ukranian]
  12. Rispoli R, Donati L, Bartolini N, Bolli L, Sulis AМ, Zofrea G., Passalacqua GP and Carletti S. Rupture of an Intracranial Arteriovenous Malformation (AVM) in Pregnancy: Case Report. Journal of Stem Cell Research & Therapy. 2015; 5(1): 1-3.
  13. Plasencia AR, Santillan A. Embolization and radiosurgery for arteriovenous malformations. Journal of surgical neurology international. 2012; 3: 90-104. https://doi.org/10.4103/2152-7806.95420
  14. Matthew EF. What Is the Risk of Hemorrhage During Pregnancy for a Woman with Brain Arteriovenous Malformation? Journal of Neurosurgery. 2017; 48: 1507-1513. https://doi.org/10.1161/STROKEAHA.117.016828
  15. Xianli L, Peng L, Youxiang L. The clinical characteristics and treatment of cerebral AVM in pregnancy. The neuroradiology journal. 2015; 28(3): 234-237. https://doi.org/10.1177/1971400915589692