• Richard Chiu, Ryan G Chiu, Faraaz Azam, Srivats Srinivasan, Amy Zheng, and Jonathan A White.
• University of Illinois College of Medicine, Chicago, IL, USA.
• World Neurosurg. 2025 Jan 29: 123738123738.

ObjectiveThe safety of spontaneous vaginal delivery in pregnant patients with known unruptured intracranial aneurysms (UIAs) has been supported by increasing evidence over the past two decades. However, the extent to which this increased evidence has since influenced changes, if any, in actual clinical practice, has yet to be studied.MethodsUsing the 2012 to 2020 Nationwide Inpatient Sample (NIS), trends in vaginal versus caesarian delivery among mothers with UIAs were assessed in temporal fashion and compared to overall trends in delivery modality during the same period. Demographic, hospital, and insurance characteristics were also assessed for relationship with method of delivery.ResultsA total of 6,624,556 obstetrical patients presented for elective delivery in the 2012-2020 NIS. This included 419 patients with UIA included in the final analysis. Patients in later years were over twice as likely to have been given a trial of vaginal delivery (OR 2.01, 95% CI 1.29 to 3.14, p = 0.002). This was also statistically significantly different from overall rates of vaginal versus caesarian delivery in the overall cohort (p < 0.001). Hospital, regional, demographic and payer characteristics analyzed were not significantly associated with delivery method.ConclusionThere was a significant trend over the 2010s toward permitting more spontaneous vaginal deliveries for obstetrical patients with known UIAs.Copyright © 2025 The Author(s). Published by Elsevier Inc. All rights reserved.

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