Pregnancy‐Related Stroke

Hemorrhagic Stroke in Pregnancy

“…Recurrent stroke risk is estimated to be 0.7% and is <1% if the inciting neurological lesion was repaired. 1 Risk of stroke increases with increasing maternal age, non-White race, and chronic hypertension. 10 Management of hypertension and diabetes mellitus is important to prevent recurrent stroke.…”

“…Hemorrhagic stroke leads to intracranial hemorrhage, which is defined as bleeding from small arteries or arterioles directly into the brain or more rarely, can lead to subarachnoid hemorrhage (SAH), which is described as bleeding into the subarachnoid space between the arachnoid membrane and pia matter with a classic presentation of severe “thunderclap” headaches 1. Pregnancy-related stroke is defined as a hemorrhagic or ischemic stroke that occurs any time during pregnancy or the first six weeks postpartum.…”

“…CT head is the first line for diagnosing hemorrhagic stroke in pregnant women and is acceptable even if the pregnancy status has not been established 17. Standard noncontrast CT radiation levels of 1 to 10 mGy1,22 are not associated with an increased risk of fetal abortion, malformation, or other adverse pregnancy outcomes 23. Fetal exposure to ionizing radiation should be minimized by shielding the abdomen and pelvis and also minimizing additional scans.…”

“…In pregnant women, as with hypertensive disorders of pregnancy, severe ranging BPs should be treated with goals of <140/<90 mm Hg. First-line agents include labetalol, methyldopa, long-acting nifedipine, and hydralazine 1,17. Institutional protocols regarding magnesium infusion for the reduction of seizure risk should be followed.…”

“…It has been suggested that if the gestational age is >28 to 32 weeks, cesarean delivery before craniotomy may improve fetal outcomes, given the fetal risk of neurosurgery 32. Fetal status should be optimized as much as possible before and during surgery, which may include continuous maternal cardiac monitoring, replacement of blood and clotting factors, avoiding drugs that may induce uterine relaxation or fetal depression, and positioning in the left lateral supine position if allowed by the neurosurgeon 1…”