Abstract 293: Review of Clinical Outcomes in Vaginal Versus Cesarean Delivery for Patients with Cerebral Arteriovenous Malformations
Bibliographic record
Abstract
Background and Purpose Cerebral arteriovenous malformations (AVMs) present a significant hemorrhage risk during pregnancy. Although physiological changes in pregnancy could theoretically increase the likelihood of rupture, the optimal delivery mode (vaginal vs. cesarean section) remains controversial. This review systematically compares maternal, neurological, and neonatal outcomes by delivery mode, evaluating the incidence and timing of AVM hemorrhage, as well as factors influencing delivery choice. Methods A systematic literature search was conducted across PubMed, Embase, Cochrane Library, Scopus, and Web of Science using relevant keywords. Studies were included if they reported original research on delivery outcomes in pregnant patients with AVMs. Exclusion criteria comprised non‐English articles, animal studies, and single case reports. Methodological quality and certainty of evidence were assessed using the Newcastle‐Ottawa Scale and GRADE approach. Results 18 studies were included in this review. Pooled AVM hemorrhage incidence during pregnancy ranged from 0.16‐0.18 per pregnancy, with conflicting evidence on pregnancy‐associated risk. Labor and delivery appeared to carry a lower risk of rupture compared to later stages of pregnancy. No definitive evidence supports increased AVM bleeding risk with vaginal delivery or prevention by cesarean section. Maternal mortality from hemorrhage ranged from 4.6‐28%; neonatal outcomes were generally favorable, with no significant difference observed between delivery modes. Conclusions The current evidence, drawn primarily from observational studies, provides low to moderate certainty regarding the safety and efficacy of delivery modes for pregnant patients with AVMs. No strong evidence suggests that vaginal delivery increases AVM rupture risk or that cesarean section provides protective benefit. Multidisciplinary care remains essential. Future research requires larger, standardized registries to develop robust, evidence‐based guidelines to optimize delivery mode selection for these patients. image
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.006 | 0.036 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.009 | 0.007 |
| Bibliometrics | 0.009 | 0.010 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.007 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".