Pre-existing,incidental and hemorrhagic AVMs in pregnancy and postpartum: Gestational age,morbidity and mortality,management and risk to the fetus

Abstract

Objective

The objective of this article is to analyze the maternal and fetal outcomes of pregnancies that present with arteriovenous malformations (AVMs).

Methods

A literature review was performed that analyzed 65 cases of AVM during pregnancy previously reported in English literature.

Results

Sixty-five cases of pregnancy-associated AVM were identified. The patients’ ages ranged from 16 to 45 years, with a mean of 28 ± 4.9 years. Sixteen cases (24.6%) were pre-existing AVMs. There were 54 cases (83.1%) of AVM ruptured during pregnancy and postpartum: Six cases (11.1%) were in the first trimester, 24 (44.4%) were in the second, 22 (40.7%) were in the third trimester and two (3.7%) were postpartum. Unfavorable maternal clinical outcome (modified Rankin Scale (mRS) ≥ 2) was identified in 20 cases (30.8%) and abortion occurred in 10 cases (15.4%). There were three maternal deaths, yielding a case mortality rate of 4.6%. Fifty-three fetuses were born via cesarean section in 42 cases and vaginal delivery in 10 cases; 48 were in good health, three were temporarily intubated, one was macrosomic and one died. In univariate analysis, AVM hemorrhage presentation was significantly associated with a poor maternal outcome (mRS ≥ 2) (p = 0.030); however, not significantly associated with fetus risk (p = 0.864). Gestational age was not significantly associated with poor maternal outcome (p = 0.875) or fetal risk (p = 0.790).

Conclusion

AVM hemorrhage presentation was significantly associated with poor maternal outcome. Pre-existing ruptured AVM may not be associated with fetal risk. Gestational age of AVM rupture was not significantly associated with poor maternal outcome or fetal risk.