Comparative Clinical Outcomes of Vaginal and Cesarean Delivery in Pregnant Patients with AVMs

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.