Management of Patients with Unruptured Cerebral Arteriovenous Malformations During Pregnancy and Childbirth

Cerebral arteriovenous malformations (AVM) are fistulous connections between arterial and venous blood flow, consisting of an abnormal tangle of dysplastic arteries and veins, without capillary vessels or interposed functional brain parenchyma. Management of pregnant patients with unruptured AVMs remain a dilemma for both obstetricians and neurosurgeons, due to the scarcity of data about this condition. Decisions are made weighting the risk of bleeding during pregnancy and the neurological status of the patient against the risks associated with a neurosurgical intervention. Most studies suggest that the bleeding risk does increase slightly during pregnancy, but further large prospective studies are needed. This article selects and reviews literature data to convey recommended management strategies for unruptured cerebral vascular malformations during pregnancy, childbirth and puerperium.