Splenic artery aneurysm in pregnancy: A systematic review.

Autor: Aung YY; Queen's Hospital, Barking, Havering and Redbridge University Hospitals NHS Trust, Essex, UK., Berry C; Imperial College School of Medicine, Imperial College London, London, UK., Jayaram PR; Department of Radiology, Northwick Park Hospital, London Northwest University Healthcare NHS Trust, London, UK., Woon EV; Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK.
Jazyk: angličtina
Zdroj: International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics [Int J Gynaecol Obstet] 2023 Jan; Vol. 160 (1), pp. 1-11. Date of Electronic Publication: 2022 Jun 14.
DOI: 10.1002/ijgo.14278
Abstrakt: Objective: Splenic artery aneurysms (SAA) are associated with significant maternal and fetal mortality when ruptured in pregnancy. However, there is no consensus on the optimal obstetric management of both ruptured and asymptomatic SAA. We aimed to evaluate risk factors, presentation, investigation, and management of SAA in pregnancy and puerperium.
Methods: MEDLINE, EMBASE, and Scopus were screened from January 2000 to October 2020 using keywords related to pregnancy and SAA. Articles on ruptured and unruptured SAA in pregnancy until 6 weeks postpartum were considered. Data were extracted by two independent reviewers. Quantitative analysis and narrative synthesis were used.
Results: Seventy-five ruptured and nine unruptured SAA cases were included. Mean age was 31.1 ± 5.2 years, of which 47 (64.4%) were multiparous and 46 (54.8%) presented in their third trimester, largely with epigastric and left-sided abdominal pain. The double-rupture phenomenon of delayed blood loss and symptoms was noted in 11 (14.7%); 60 (70.7%) underwent preoperative imaging. Mean SAA size was 23.0 ± 13.6 mm. Ruptured SAA were primarily managed by laparotomy (61, 81.3%) typically with splenectomy,  and unruptured SAA by embolization or laparotomy. There was no mortality in unruptured SAA, but significant mortality on rupture (19, 25.7% maternal; 36, 50.0% fetal).
Conclusion: Given their predisposition and high mortality in pregnancy, it is crucial that SAAs are promptly diagnosed and managed, requiring increased obstetrician awareness.
(© 2022 International Federation of Gynecology and Obstetrics.)
Databáze: MEDLINE
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