Delivery management and related complications in pregnant women with brain arteriovenous malformation: A systematic review

Brain arteriovenous malformation (BAVM) is a rare condition. Regarding considerable risk of hemorrhage and subsequent complications, pregnant women with BAVMs are classified as high-risk patients. The aim of this review is to evaluate different aspects of BAVM during pregnancy leading to an appropriate comparison of delivery methods in those patients. A systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria, reviewing 784 articles between 1974 and 2024. Articles were selected by searching the MEDLINE, Embase, Scopus, Web of Science, and Cochrane electronic bibliographic databases. 18 papers were included for systematic review. Outcome results were discussed via Glasgow Outcome Scale and Apgar score. Out of 171 patients with age reference of 27–31 (25th-75th percentile) and median of 28, cesarean section (CS), normal vaginal delivery (NVD) and abortion were reported in 75, 55, and 26 patients, respectively. The status of delivery in three patients was not reported. Most patients had headaches while nausea, vomiting, and dizziness were also reported as other symptoms. Newborns had similar stable condition after birth in both groups. Maternal postpartum and postprocedural status was good except for 6 maternal deaths. Based on available data there is no demonstration of a clear difference between CS or NVD in clinically stable patients. While, in cases of instability, CS is preferred to minimize the complications. Conclusively, delivery plan should be individualized for each patient, considering both neurosurgical and obstetric conditions for optimal outcome. • No significant difference between CS and NVD in clinically stable BAVM patients. • CS is preferred in cases of maternal or fetal instability to minimize risks. • Decision for delivery method should be individualized for BAVM patients. • Consider both obstetric and neurosurgical conditions for optimal outcomes.