SUBARACHNOID HEMORRHAGE
Specifics of SAH treatment during pregnancy
Created 20/10/2021, last revision 11/01/2023
- the risk of rupture during pregnancy and delivery is relatively low (1.4 and 0.05%, respectively) and close to the general population ⇒ conservative approach
| Content available only for logged-in subscribers (registration will be available soon) |
- general anesthesia is preferred
- it is important to:
- maintain placental perfusion and fetal oxygenation – to avoid hypoxia, hypotension, hypocapnia, acidosis, and hypothermia
- adequate maternal brain perfusion and prevention of progression of cerebral edema and ↑ ICP
- hemodynamic stability (avoid both hypotension and hypertensive attacks with increased risk of rebleeding)
- invasive BP measurement is preferred
- use a shield to protect the fetus
- according to the ICRP (International Commission on Radiation Protection), abortion is recommended at a dose > 100 mGy
- according to the experiment, the measured dose during a conventional endovascular procedure was about 2.8 mGy
- most commonly, iohexolomnipaque is used
- no fetal harm or fertility problems have been reported (animal studies with 100x higher dose); human studies are not available
- always consider the risk-benefit ratio before using a contrast agent; use the lowest dose possible
- use heparin, which does not cross the placenta, and its effect can be easily neutralized
- standard monitoring (ECG, blood pressure, O2 saturation, temperature, ETCO2)
- intraoperative invasive BP monitoring
- fetal heart rate (FHR) monitoring
- if problems are detected, neutralize heparin and perform an emergent cesarian section
- fluid balance
- consider central venous catheter
- extended neuromonitoring
- EEG
- SSEP, MEP
| Content available only for logged-in subscribers (registration will be available soon) |
- maintain normotension to preserve maternal CPP and prevent intrauterine asphyxia
- invasive blood pressure (BP) monitoring is recommended
- consider central venous catheter (CVC) placement:
- enables central venous pressure (CVP) monitoring
- allows administering more fluids and concentrated solutions
| Content available only for logged-in subscribers (registration will be available soon) |
- nimodipine, according to animal studies, increases the risk of growth retardation and congenital defects – consider the risk-benefit ratio
- it is often used in routine practice
- magnesium sulfate
- reduces the severity of vasospasms (VSP)
- according to the MASH-2 (Magnesium for aSAH) study, but does not improve the outcome
- reduces the severity of vasospasms (VSP)
- the risk of VTE is increased during pregnancy ( 4-5 times, according to some sources)
- it is safe to use intermittent pneumatic compression (IPC)
- medical prophylaxis only after the aneurysm is secured (consult with a neurosurgeon)
