A Clinical Study of Neurological Complications in Pregnancy and Upto 6 Weeks Postpartum

Abstract

BACKGROUND Pregnancy is associated with major hormonal changes and other physiological changes. Several neurological conditions may appear during pregnancy that are either unique to or occur with increased frequency during pregnancy and puerperium. Preexisting disorders such as epilepsy may worsen in one-third of pregnant patients and seizures are common during peripartum period. Changes in haemodynamics, blood volume and hormonal effects on the vessel wall increase risk of cerebrovascular disorders during pregnancy and the postpartum period. Cerebral venous sinus thrombosis is common in the postpartum period. Brain tumours may enlarge during pregnancy because of fluid retention and the presence of oestrogen and progesterone receptors on the tumour cells. Neurological disorders may influence the management of obstetric outcomes. In this study, the common neurological problems during pregnancy and six weeks of postpartum period are discussed. Aim-To study the neurological disorders and clinical features occurring during pregnancy and 6 weeks of postpartum. MATERIALS AND METHODS This was a descriptive study carried out in Osmania, Hyderabad (December 2015-January 2018). Source of Data: All the pregnant women attending OP and admitted as inpatients in Osmania General Hospital. Total 67 patients attending Outpatient Department of Neurology and admitted in the hospital with neurological disorders were included. Patients with neurological disorders due to trauma, infections and obstetrical procedures were excluded from the study. A total of 67 patients were included in the study and consent was taken from them. Demographic data and data of history and detailed examination were collected. Basic and relevant investigations were done including Brain Imaging, CSF analysis, EEG, NCS, 2D Echocardiography and ANA profile whenever necessary. RESULTS Most patients were in the age group of 21-25 years (61%). Age of patients ranged between 19-35. Most patients presented in postpartum period (41%). Seizures (46%) was the most common presentation followed by stroke (36%). Most of the patients (45%) with seizures were in 2 nd trimester. 87.5% patients with stroke presented in postpartum period. 3 patients had facial palsy. 2 patients presented with astrocytomas and 3 patients had chorea. CONCLUSION Many neurological disorders are encountered in pregnancy. In our study, we have identified 7 different conditions, of which seizures was the most common presentation. Effect of the condition and its treatment on pregnancy and vice versa should always be kept in mind. Appropriate management with collaborative effort of obstetricians, neurologists, neurosurgeons and paediatricians at specialised centres should be undertaken for successful maternal and foetal outcomes.