PREGNANCY AND CHILDBIRTH FOLLOWING CLIPPING OF A RUPTURED MIDDLE CEREBRAL ARTERY ANEURYSM ASSOCIATED WITH SUBARACHNOID HEMORRHAGE (A CLINICAL CASE)
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Abstract
Aneurysmal subarachnoid hemorrhage (SAH) during pregnancy is a rare, life-threatening condition. Obstetric management strategies for subsequent pregnancies in women who have previously undergone microsurgical aneurysm clipping outside of pregnancy remain significantly understudied. This case report demonstrates that given complete surgical obliteration of the aneurysm, a stable neurological status, remote collaboration with federal expert centers, and coordinated teamwork among the obstetrician-gynecologist, neurologist, and neurosurgeon it is possible to carry a pregnancy to term and deliver without neurological complications. These findings support a shift away from overly categorical regulatory guidelines toward a risk-based, individualized approach. The article presents the clinical case of a 28-year-old pregnant woman with a significant neurosurgical history: two years prior to the current (fourth) pregnancy, she suffered an SAH caused by the rupture of a saccular aneurysm at the bifurcation of the M1 segment of the left middle cerebral artery, requiring aneurysm clipping and two reconstructive cranioplasties. Pregnancy management was conducted by a multidisciplinary team (obstetrician-gynecologist, neurologist, and neurosurgeon) with remote consultations from federal centers. Delivery was achieved via operative intervention at 38 weeks of gestation. The postoperative period was uneventful, with no neurological complications.
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1. Khatibi K, Saber H, Patel S, Mejia LLP, Kaneko N, Szeder V, et al. Aneurysmal subarachnoid hemorrhage in pregnancy: National trends of treatment, predictors, and outcomes. PLoS One. 2023; 18(5): e0285082. doi: 10.1371/journal.pone.0285082
2. Maeoka R, Ohnishi H, Matsuda R, Nakagawa I. Endovascular treatment for subarachnoid hemorrhage during pregnancy followed by minimum approaches for cerebral vasospasm. Surg Neurol Int. 2026; 17: 239. doi: 10.25259/sni_96_2026
3. Shaaban A, Ashok AH, Borchert R, Cammarano C, Miller L, Nourallah B, et al. Deciding the timing of aneurysm coiling and obstetric delivery in pregnant patients presenting with ruptured intracranial aneurysms: a case report and review. BJR Case Rep. 2026; 12(2): uaag012. doi:10.1093/bjrcr/uaag012
4. Kim YS, Joo SP, Kim TS. Management of Aneurysmal Subarachnoid Hemorrhage During Pregnancy with a Devastating Clinical Course: A Case Report. J Clin Med. 2026; 15(7): 2718. doi:10.3390/jcm15072718
5. Chiu R, Chiu RG, Azam F, Srinivasan S, Zheng A, AWhite J. Trend toward vaginal versus cesarean deliveries in pregnant patients with unruptured intracranial aneurysms in the 2010s: a nationwide inpatient analysis. World Neurosurg. 2025; 196: 123738. doi:10.1016/j.wneu.2025.123738
6. Lal A, Sprawka N, Darji H, Waters T, Goodman JR. MRSA screening: incidence and maternal postpartum outcomes in an obstetric population at a tertiary care center. Arch Gynecol Obstet. 2022; 307(4): 1203-1208. doi: 10.1007/s00404-022-06552-x