Cerebral aneurysms in pregnancy: Considerations for diagnosis and management

The pregnant patient with an unruptured or ruptured aneurysm presents a unique challenge for clinical evaluation and management. While some studies propose that pregnancy confers increased risk of aneurysmal SAH (aSAH) due to hemodynamic changes which accompany gestation, there are other studies that negate this association. This chapter focuses on the special considerations for diagnosis, counseling, and management of these lesions in pregnant patients. The presence of a cerebral aneurysm should not deter pregnancy, although intervention in higher risk patients prior to conception is reasonable. An unruptured aneurysm discovered during pregnancy may be surveilled with noninvasive imaging. Delivery, vaginal of cesarean, should be guided by obstetric considerations in pregnant patients with unruptured aneurysms. Ruptured aneurysms in pregnancy should be managed according to neurosurgical indications and, when feasible, delivery via cesarean (C)-section should proceed prior to surgical intervention. Decision making in these difficult scenarios should seek to provide optimal maternal care while minimizing harm to the fetus.