Pregnancy and Clinical Risks of Spinal Cord Arteriovenous Shunts: A Nationwide Multicenter Retrospective Cohort Study
Bibliographic record
Abstract
BACKGROUND AND OBJECTIVES: Intermittent reports of spinal cord arteriovenous shunts (SCAVSs)-induced paralysis during pregnancy and puerperium have raised significant concerns. This study aimed to assess whether women with SCAVSs are at an elevated clinical risk during this period. METHODS: Consecutive female patients with SCAVSs from 10 referral centers were included. Only clinical data within reproductive age were analyzed. The primary outcome was the occurrence of clinical deterioration associated with SCAVSs, categorized into acute and gradual patterns based on the modified Aminoff and Logue scale. RESULTS: A total of 480 patients were included. Before initial treatment, 262 patients experienced pregnancy. Both acute (17.88%/y vs 4.87%/y, P < .0001) and gradual (9.67%/y vs 3.27%/y, P < .0001) deterioration during pregnancy and puerperium were significantly elevated. In the matched cohort of 72 pregnant patients with untreated SCAVSs and their nonpregnant control, acute deterioration was significantly higher in the pregnant patients (26.09%/y vs 6.97%/y, P = .013). After partial SCAVSs obliteration, acute (33.74%/y vs 5.15%/y, P < .0001) and gradual (18.40%/y vs 2.61%/y, P = .0008) deterioration rates during this period were still significantly elevated. In the matched cohort of 23 pregnant patients with residual SCAVSs and their nonpregnant control, acute deterioration was still significantly higher in the pregnant patients (39.50%/y vs 6.25%/y, P = .043). In addition, no significant decrease in the clinical deterioration was observed after partial treatment compared with nontreated patients during this period. CONCLUSION: The risk of clinical deterioration associated with SCAVSs is significantly elevated during pregnancy and puerperium.
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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 | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 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".