CEREBRAL VASCULAR DISEASE IN PREGNANCY I. HAEMORRHAGE

Summary Fifty‐two patients with intracranial haemorrhage have been studied, of whom 40 were pregnant and 12 recently delivered. Angioma was encountered more often than aneurysm in the pregnant group. The relative rarity of these lesions makes management difficult to plan for the individual clinician. The possibility of cerebral disease should be considered in any patient with recurrent headache or neurological symptoms. The fact of pregnancy should not deter full investigation including lumbar puncture and cerebral angiography, if clinically indicated. There was a considerably higher incidence of hypertension among patients with cerebral aneurysms compared with those with other lesions. Intracranial bleeding in a hypertensive patient should not be assumed to be a secondary phenomenon without further investigation, and a diagnosis of “atypical eclampsia” should be regarded with suspicion. Patients with severe hypertension require long‐term follow‐up. Unless labour begins during investigation a cerebral lesion should be treated before delivery irrespective of the stage of pregnancy and the method of treatment should be decided primarily on neurosurgical grounds. Conversely, the mode of delivery need not be unduly influenced by the cerebral lesion. The rarity of intracranial bleeding during labour is confirmed in this series, and is supported by haemodynamic considerations. Caesarean section carries no demonstrable advantage for mother or child over controlled vaginal delivery, even when the lesion has not been surgically obliterated. Forceps delivery under sedation and regional anaesthesia is the method of choice. Pregnancy per se does not influence the mortality from intracranial bleeding in young women, but haemodynamic and hormonal changes may explain an increased tendency for vascular anomalies to bleed in the second half of pregnancy, especially in the presence of hypertension. Recurrent bleeding did not occur in nine patients who became pregnant again. The question of further childbearing should be decided individually and based on obstetric rather than neurological grounds.