Deciding the timing of aneurysm coiling and obstetric delivery in pregnant patients presenting with ruptured intracranial aneurysms: a case report and review

Abstract The optimal treatment strategy for intracranial aneurysms (IA) in pregnancy is unclear, particularly in the third trimester of pregnancy and during the intrapartum period. We discuss a case of a ruptured IA at 39 + 3 weeks of gestation, during prelabour and review literature focusing on the order of treatment and delivery. A 4 x 6 x 3 mm aneurysm arising from the left posterior communicating segment of the internal carotid artery was embolised with multiple detachable coils, followed by a caesarean section (CS) with good maternal and foetal outcomes. Our review of the literature identified 29 reported cases of ruptured intracranial aneurysms in pregnancy. After 22 weeks of gestation, mortality was higher amongst patients who delivered first (3/9) compared to those who were coiled first (1/11). Our case and the published literature support the approach of securing the aneurysm before delivery to improve maternal outcomes.