Pregnancy‐Associated Stroke

Abstract

Cerebrovascular accident, or stroke, is the fourth leading cause of death for all women and the eighth leading cause of pregnancy-associated death. The physiologic changes of pregnancy increase the risk of cerebrovascular accident for women. With current incidence rates, a facility with 3300 births per year can anticipate caring for one woman with a pregnancy-related stroke at least every 2 years. All maternity care providers must be able to assess women experiencing stroke-like symptoms and initiate timely care to mitigate brain tissue damage, decrease long-term morbidity, and prevent mortality. The 2 main types of stroke, ischemic and hemorrhagic, have similar presenting symptoms but very different pathophysiology and treatment. This article reviews assessment and initial treatment of pregnant and postpartum women experiencing stroke and provides guidance for subsequent maternity and primary care to assist front-line perinatal care providers who may be the first to treat affected women or may resume primary care after diagnosis.

Early pregnancy‐associated ischemic stroke during first trimester in a young woman: A case report

“…If she also has factors that contribute to clot formation, such as vascular defects or injuries, her risk of a thromboembolism is greatly increased. 5 Ischemic stroke can thus be related to other conditions exclusively associated with pregnancy including preeclampsia, eclampsia with HELLP syndrome or posterior reversible encephalopathy syndrome, postpartum cardiomyopathy, cerebral angiopathy, choriocarcinoma with trophoblastic embolism or cerebral metastases with direct vascular damage, and amniotic fluid embolism, 1,2 which were eliminated in our patient. However, up to 40% of ischemic strokes have no identifiable cause despite investigations and are regarded as cryptogenic similar to our case.…”

“…The increased cardiac output may exacerbate or cause structural changes, resulting in turbulent blood flow around cardiac or major vessel abnormalities increasing the risk of formation of clots that can dislodge and cause ischemic strokes. 5 A failure to adapt to all of these changes can result in cardiovascular complications in pregnant women with known cardiac disease, or even reveal an unknown underlying cardiac disease. 2 Hypercoagulability beginning at 11 weeks, results from an increase in coagulation factors VII, X, XII, fibrinogen and plasminogen activator inhibitors, and a decrease in anticoagulant factors protein C and antithrombin, especially during the third trimester and in early postpartum.…”

Impact of preeclampsia/eclampsia on hemorrhagic and ischemic stroke risk: A 17 years follow-up nationwide cohort study

“…Many studies evaluated the stroke risk during the pregnancy period [11,[40][41][42][43][44][45], puerperium [42], and postpartum [40,46]. Among these risk factors evaluated in the studies, preeclampsia/eclampsia was one of the risk factors which might increase the incidence of stroke.…”

Pregnancy-Related Stroke: A Review

“…An ischemic stroke is defined as a permanent or temporary lack of blood flow to the brain resulting in cell death 5 . Ischemic strokes are the most common types of strokes in the perinatal period and are most commonly caused by thrombotic emboli 5 . Outside of pregnancy, atherosclerotic plaques are a major cause of ischemic stroke; however, it is a rare cause of perinatal ischemic stroke 5 …”