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Department of Obstetrics and Gynecology at Harvard Medical School, Beth Israel Hospital, Boston, Massachusetts.
The number of women harboring unruptured congenital berry aneurysms during pregnancy is astonishingly high. Despite this, only 142 documented cases in which intracranial aneurysms ruptured prior to or during pregnancy have been reported. These reports present conflicting views regarding the optimum management of pregnancy and the perinatal period in such patients. We report here in detail 3 patients who went through pregnancy, labor, and delivery subsequent to rupture of an intracranial aneurysm. One patient had delivered once before rupture, another twice before rupture, and the third delivered twice before rupture and three times after rupture. In all patients, surgical treatment of the aneurysm was attempted during the nonpregnant state, but it was successful in only 2. All patients progressed to term without recurrent hemorrhage. In two instances labor was allowed to begin spontaneously and in the third, labor was induced. In each case, mother and fetus were intensively monitored during labor. Two patients delivered vaginally and I patient underwent cesarean section for an obstetric indication. All mothers and offspring did well. The literature was reviewed, and, on the basis of accumulated evidence, there appears to be little indication for elective cesarean section in patients with previous intracranial hemorrhage due to ruptured cerebral aneurysms.
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