00:00So this headache in pregnancy is always a red flag sign and you have to understand
00:04this is where we become problematic when they have a light headache because
00:09CT scans are not safe for pregnancy. So we need to do MRI for them.
00:14So sometimes they will say, okay, we push for the MRI
00:17but in a dire emergency cases where they already in your emergency department
00:22we say we have no choice. We have to proceed with the CT brain.
00:25We have to become mother first. We try to save the mother first.
00:28So how is it challenging in managing a pregnancy with the intracranial bleed?
00:33The first word challenging is pregnant lady.
00:37So the moment my medical officer will call and say, boss, I have a pregnant lady case.
00:43You know, even at what time our eyes are wide open, we won't even see the scan.
00:47We will just jump into our computers or laptop to see, look at the scan
00:51because our decision need to be very accurate and fast.
00:55So when you're pregnant, your body changes.
00:59So your blood flow is increased.
01:02So what happened with this?
01:03This is a time when something that was not diagnosed can be diagnosed.
01:08Like mostly the cases like that I operated and I experienced throughout my service,
01:14usually they don't know they have aneurysm.
01:17They don't know they have an AVM.
01:18Because if they were diagnosed before the pregnancy, we will advise them in a lot of methods
01:25what you're supposed to do.
01:27So what happened was the blood flow changes the hemodilution.
01:31Because your blood become thick, sometimes thin, and you'll be on medication,
01:36and sometimes you can be stressed, right?
01:38And you can strain and everything.
01:41This caused the blood flow to show up, increase more to your brain.
01:44And this, the basic pathology is the aneurysm might be there.
01:49Like, you know, like I said, one out of ten of us might be walking with aneurysm.
01:55So what happened, the body changes cause that symptoms to start to appear.
02:00Like particularly, go back, they will have a headache.
02:04So this headache in pregnancy is always a red flag sign.
02:07And you have to understand, this is where we become problematic when they have a light headache
02:12because CT scans are not safe for pregnancy.
02:14So we need to do MRI for them.
02:17So sometimes they will say, okay, we push for the MRI.
02:21But in a dire emergency cases where they already in your emergency department,
02:25we say we have no choice.
02:26We have to proceed with the CT brain.
02:28We have to become mother first.
02:30We try to save the mother first.
02:32But it's very tragic because aneurysm ruptured is one minute time bomb.
02:37So I will say not one, 30 seconds because you are talking now, you can drop in next 30 seconds.
02:44So in this case, like particular case or certain aneurysm in pregnancy, never be small.
02:51Like example, that size is not like 2mm or 3mm.
02:54It can be 10mm, it can be 15mm.
02:57MM sounds small, but when you do a surgery, we call it a giant aneurysm.
03:01You know, it's called giant anything more than 10mm.
03:04Oh, sorry, 15mm.
03:05So, and when you have a giant aneurysm in pregnancy, that make you to sit down and think,
03:11what am I supposed to do?
03:12So this is where we will call and say, you know what, you have to take out the baby.
03:17I have to operate on a brain.
03:19So I think there are most of the time, sometimes I'll be waiting to start until the baby deliver.
03:24The moment I heard the baby sound like crying, okay, I said, can I start?
03:28Can, bomb.
03:28So I start.
03:35So, let's do that.
03:35So I think there's a little bit of a baby.
03:36So, let's do that.
03:36So, let's do that.
03:37So, let's do that.
03:37So, let's do that.
03:38So let's do that.
03:39So, let's do that.
03:39So, let me see.
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