Features of the course of pregnancy, childbirth and the postpartum period in women with cerebrovascular pathology and assessment of perinatal outcomes

AIM: The aim of this study was to investigate the features of the course of pregnancy, childbirth and the postpartum period in women with cerebrovascular pathology and to assess the choice of the optimal method of delivery and perinatal outcomes.

MATERIALS AND METHODS: This study assessed ten cases of pregnancy and delivery in women with cerebrovascular pathology (arteriovenous malformation (50%), cavernous malformation (30%), and arterial aneurysms (20%)). All women were followed up, treated and delivered at the Obstetrics and Gynecology Clinic (Academician I.P. Pavlov First Saint Petersburg State Medical University, St. Petersburg, Russia) between 2018 and 2019.

RESULTS: In eight out of ten women with cerebrovascular pathology, the course of pregnancy was complicated by the threat of premature birth, chronic placental insufficiency, and severe preeclampsia. In one case, the pathology of the cerebral blood vessels (cavernous malformation) manifested itself as a general hemorrhagic disturbance of the cerebral blood circulation during this pregnancy; in all other cases, cerebrovascular pathology was diagnosed before pregnancy. When analyzing the timing of delivery, it should be noted that only in one case with severe preeclampsia, the pregnancy was completed at 34 weeks and 1 day (emergency childbirth). The average delivery time for the remaining patients was 38 weeks ± 3 days (planned childbirth). The analysis of delivery methods showed that in 90% of cases (n = 9), pregnant women were delivered by caesarean section. Vaginal delivery occurred in one patient with a history of arteriovenous malformation of the left frontal lobe after subtotal embolization. The course of the postpartum period in all the patients was uneventful. During the next year, a planned consultation with a neurologist took place in three cases.

CONCLUSIONS: It is required that a multidisciplinary team should develop tactics for pregravid preparation, pregnancy and postpartum management, with an assessment of long-term consequences in pregnant women with cerebrovascular disease, which will improve the efficiency of medical care and will contribute to the further implementation of reproductive functions in such patients. It is necessary to develop rehabilitation plans with the selection of personalized rehabilitation methods aimed at reducing complications associated with pregnancy and childbirth.