For women with aneurysms involving the brain blood vessels, pregnancy and delivery don't appear to increase the risk of aneurysm rupture, reports a paper in the February issue of Neurosurgery, official journal of the Congress of Neurological Surgeons. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.
The study also finds that women with known, unruptured aneurysms have a very high rate of cesarean delivery-which isn't supported by evidence and "may not be necessary," according to Dr. Brian L. Hoh of University of Florida, Gainesville, and colleagues.
Pregnancy Doesn't Increase Risk of Aneurysm Rupture
The researchers used a national hospital database (the Nationwide Inpatient Sample) to estimate the risk of brain aneurysm rupture during pregnancy and delivery. An aneurysm is a weakened spot in a blood vessel wall. If the aneurysm enlarges or ruptures (breaks), it can cause life-threatening bleeding in the brain.
The database identified 714 women hospitalized for ruptured aneurysm during pregnancy and 172 during delivery between 1988 and 2009. Based on an estimated rate of 1.8 percent among women of childbearing age, Dr. Hoh and colleagues calculated that, across the United States, approximately 49,000 women with unruptured aneurysms were hospitalized during pregnancy and 312,000 during delivery.
Using these figures, the researchers estimated a 1.4 percent risk of aneurysm rupture during pregnancy and 0.05 percent during delivery. Based on previous studies, these rates were "comparable with the risk of aneurysm rupture in the general population," Dr. Hoh and coauthors write.
Women with ruptured aneurysms were at high risk of poor outcomes-including maternal mortality rates of 9.5 percent for those with rupture during pregnancy and 18 percent with rupture during delivery. The risk of poor outcomes appeared lower for women who underwent treatment for ruptured aneurysms: either surgical clipping or less-invasive, endovascular "coiling." However, because of the relatively small number of patients, these differences were not statistically significant.
High Rate of Cesarean Section May Be Unnecessary