Anesth Pain Med.  2017 Jul;12(3):220-223. 10.17085/apm.2017.12.3.220.

Anesthetic management during cesarean delivery in a pregnant woman with ruptured cerebral arteriovenous malformation: A case report

• Sim JH
• Lee JH
• Lee CH
• Ryu SA
• Choi SS

• KMID: 2388835
• DOI: http://doi.org/10.17085/apm.2017.12.3.220

Abstract

Although intracranial hemorrhage from arteriovenous malformation (AVM) during pregnancy is rare, it can have fatal consequences. Anesthetic techniques for these patients should ensure precise hemodynamic control, and the goals of anesthesia should include both fetal and maternal well-being. We report a case of anesthetic management for cesarean section in a 31-year-old woman who presented at 32 weeks gestation with an acute intracranial hemorrhage secondary to rupture of a previously diagnosed AVM. Our medical team decided to perform emergent cesarean section under regional anesthesia before transferring the patient to the neurosurgical intensive care unit for further monitoring and appropriate postoperative pain control. The patient was alert and cooperative during neuraxial anesthesia. The operation was successful, and the patient showed gradual improvement in neurosurgical status after several days. We concluded that in case of emergency, regional anesthesia can be a safe strategy for cesarean section in a pregnant woman with symptomatic AVM.

Keyword

Arteriovenous malformation; Cesarean section; Pregnancy; Regional anesthesia

MeSH Terms

Adult
Anesthesia
Anesthesia, Conduction
Arteriovenous Malformations
Cesarean Section
Emergencies
Female
Hemodynamics
Humans
Intensive Care Units
Intracranial Arteriovenous Malformations*
Intracranial Hemorrhages
Pain, Postoperative
Pregnancy
Pregnant Women*
Rupture

Figure

• 

  Fig. 1 Brain computed tomography (CT) and angiography findings of a 32-weekpregnant woman with ruptured cerebral arteriovenous malformation (AVM). CT at admission shows an intracranial hemorrhage (arrow) in the right parieto occipital lobe extending to the ventricles with a mass effect causing a midline shift to the left (7 mm) with possible bilateral uncal herniation (A). CT angiography shows a residual AVM nidus of approximately 5 × 4 × 3 cm (arrow) fed by branches of cerebral and drained by an engorged draining vein (*) (B).

• 

  Fig. 2 Hemodynamic status during regional anesthesia for cesarean delivery in a pregnant woman with ruptured cerebral rteriovenous malformation. SBP: systolic blood pressure, DBP: diastolic blood pressure, HR: heart rate.

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