Stroke in pregnancy and the puerperium

Abstract

Stroke is a recognised complication of pregnancy, contributing to more than 12% of all maternal deaths. Estimated incidence rates vary considerably from 4.3 to 210 strokes per 100 000 deliveries. Atherosclerosis is rare in young adults, and so other causes of stroke become increasingly likely. Aetiological factors important in pregnancy include hypercoagulability due to maternal physiological changes, pre-eclampsia and eclampsia, cerebral venous thrombosis, paradoxical embolism, postpartum cerebral angiopathy and peripartum cardiomyopathy. Management of patients with pregnancyrelated stroke should generally proceed as for nonpregnant patients, although there are a number of important areas specific to pregnancy which will be considered here.Stroke in young adults aged 15-35 years is more common in women than in men, 1 and women also have poorer outcomes in terms of disability and dependency.2 There has been growing interest in the role of oestrogens in stroke, 3 and risk factors unique to women include pregnancy, use of oral contraceptives, and postmenopausal hormone therapy. Stroke associated with pregnancy has been recognised for many years, and is an uncommon but feared complication contributing to more than 12% of all maternal deaths.4 5 The declining incidence of direct causes of maternal death has led to an increased awareness of nonobstetric factors such as stroke. Clearly, any recognised cause of stroke in young patients may also occur coincidentally during pregnancy, although there are a number of factors associated with pregnancy that have an important aetiological role, and these will be considered here. We will also consider the current scope of the problem, and focus on relevant areas unique to pregnancy, including issues surrounding investigation and treatment options.

Terhesség és akut ischaemiás stroke

“…Bár egy korábbi tanulmány szerint az anyai halálozás 26% [32], újabb vizsgálatok 14% alatti mortalitást említenek [5]. A magzati halálozási arány körülbelül 12% [3]. A rekurrens ischaemiás stroke kockázata alacsony, 1 évre 1%, 5 évre 2% [33].…”

“…Rövidítések CT = komputertomográfia; DWI = diffusion-weighted imaging; LMWH = low molecular weight heparin; MRI = mágne-sesrezonancia-vizsgálat; rtPA = rekombináns humán szöveti plazminogén aktivátor; TOF = time-of-flight; UFH = unfractionated heparin Ischaemiás stroke-ról beszélünk, ha a neurológiai funkció zavar hátterében fokális agyi, gerincvelői vagy retinalis infarktus áll [1]. A terhesség alatt jelentkező agyi érka-tasztrófa ugyan ritka esemény, mégis az egyébként alacsony rizikójú fiatal populációban bekövetkező strokeok 12-35%-áért és az anyai mortalitás 12%-áért felelős [2,3]. A gesztáció során a legnagyobb kockázatot a szü-lés körüli és gyermekágyi időszak jelenti [4].…”

“…A terhesség alatt jelentkező agyi érka-tasztrófa ugyan ritka esemény, mégis az egyébként alacsony rizikójú fiatal populációban bekövetkező strokeok 12-35%-áért és az anyai mortalitás 12%-áért felelős [2,3]. A gesztáció során a legnagyobb kockázatot a szü-lés körüli és gyermekágyi időszak jelenti [4].…”

Medical problems in pregnancy

“…2 One reason for this is that meeting inpatient referral demand is low on department priorities. It is a largely unrecorded and often poorly resourced activity.…”

“…2 Likewise, propranolol is listed as causing intrauterine growth restriction in the British National Formulary -'Betablockers may cause intra-uterine growth restriction, neonatal hypoglycaemia, and bradycardia; the risk is greater in severe hypertension' -and www.drugs.com also warns that 'this drug is only recommended for use during pregnancy when there are no alternatives and the benefit outweighs the risk' and 'beta blockers may cause decreased placental perfusion, fetal and neonatal bradycardia, and hypoglycemia'.…”