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Aneurysmal subarachnoid hemorrhage during pregnancy: a comprehensive and systematic review of the literature

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Abstract

Aneurysmal subarachnoid hemorrhage (aSAH) is an emergent condition requiring rapid intervention and prolonged monitoring. There are few recommendations regarding the management of aSAH in pregnancy. We identified all available literature and compiled management decisions as well as reported outcomes through a systematic literature review without meta-analysis to provide recommendations for management of aSAH during pregnancy. We included a total of 23 articles containing 54 cases of pregnancy-related aSAH in our review. From these reports and other literature, we evaluated information on aSAH pathophysiology, diagnosis, and management with respect to pregnancy. Early transfer to an appropriate facility with neurocritical care, a high-risk obstetric service, and a neurosurgery team available is crucial for the management of aSAH in pregnancy. Intensive monitoring and a multidisciplinary approach remain fundamental to ensure maternal and fetal health.

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Data availability

This is a systematic review according to PRIMA guidelines as stated in our method including keywords that used for our search. The data that supports the findings in this article provided in table 1including the citations. Articles cited cab be found on the PubMed, Medline, and Embase databases. No further supplementary data.

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Authors and Affiliations

  1. Department of Neurological Surgery, Tulane University, New Orleans, LA, USA

    Adam Beighley, Ryan Glynn, Tyler Scullen, Mansour Mathkour, Cassidy Werner, John F. Berry, Christopher Carr, Aimee Aysenne, John D. Nerva & Aaron S. Dumont

  2. Department of Neurological Surgery, Ochsner Medical Center, New Orleans, LA, USA

    Ryan Glynn, Tyler Scullen, Mansour Mathkour, John F. Berry & Aaron S. Dumont

  3. Neurosurgery Division, Surgery Department, Jazan University, Jazan, Kingdom of Saudi Arabia

    Mansour Mathkour

  4. Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    Hussam Abou-Al-Shaar

  5. Department of Neurocritical Care, Tulane Medical Center, New Orleans, LA, USA

    Aimee Aysenne

Authors
  1. Adam Beighley
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  2. Ryan Glynn
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  3. Tyler Scullen
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  4. Mansour Mathkour
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  7. Christopher Carr
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Contributions

All authors contributed to the design, writing, and editing of this project. Ryan Glynn and Adam Beighley conducted the data collection. Adam Beighley conducted the data analysis. The first draft was written by Adam Beighley and Ryan Glynn, and all authors commented and edited on later versions. All authors read and approved the final manuscript. Aimee Aysenne, John D. Nerva, and Aaron S. Dumont jointly supervised this work.

Corresponding authors

Correspondence to Mansour Mathkour or Aaron S. Dumont.

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Learning objectives

1. Guidelines for managing subarachnoid hemorrhage in pregnancy are limited.

2. Management should be directed primarily towards the patient unless requested otherwise.

3. A multidisciplinary approach with neurocritical care, neurosurgery, and obstetrics is necessary.

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Beighley, A., Glynn, R., Scullen, T. et al. Aneurysmal subarachnoid hemorrhage during pregnancy: a comprehensive and systematic review of the literature. Neurosurg Rev 44, 2511–2522 (2021). https://doi.org/10.1007/s10143-020-01457-2

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