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.
To evaluate risk factors, presentation, investigation and management of SAA in pregnancy and puerperium.
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 was extracted by two independent reviewers. Quantitative analysis and narrative synthesis were used.
75 ruptured and 9 unruptured SAA cases were included. Mean age was 31.1±5.2, of which 64.4% were multiparous. 60.2% 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 14.7%. 70.7% underwent pre-operative imaging. Mean SAA size was 23.0±13.6mm. Ruptured SAA were primarily managed by laparotomy with splenectomy (82.7%) and unruptured SAA by embolization or laparotomy. There was no mortality in unruptured SAA, but significant mortality on rupture (25.7% maternal, 51.4% fetal).
Given their predisposition and high mortality in pregnancy, it is crucial that SAAs are promptly diagnosed and managed, requiring increased obstetrician awareness.

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