How will your doctor work with a functioning stroke doctor to guarantee you won't have a stroke via pregnancy? This is non-negotiable!
Stroke in Pregnancy: An Update
Section snippets
Key points
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Pregnancy and puerperium confer a substantially increased risk of ischemic and hemorrhagic stroke in women, the rates of which have increased approximately 50% to 80% over the past 20 years.
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The period of highest risk of stroke is the peripartum/postpartum phase, coinciding with the highest risk for hypertensive disorders of pregnancy and peak risk of gestational hypercoagulability.
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Hemorrhagic stroke is the most common type of obstetric stroke, most commonly associated with hypertensive
Incidence, Prevalence, and Temporal Trends
Pregnancy and puerperium confer an increased risk for ischemic as well as hemorrhagic stroke, with incidence rates being 3-fold higher as compared with nonpregnant women. A recent meta-analysis of the epidemiologic characteristics and risk factors for stroke in pregnancy found that the mean age ranged from 22 to 33 years, and the crude incidence rate was 30/100,000 (95% confidence interval [CI], 18.8–49.4/100,000).1 The rate of ischemic and hemorrhagic stroke was 12.2/100,000 pregnancies,
Patient Characteristics
A study of the Nationwide Inpatient Sample showed that the absolute risk of stroke increased with age: compared with patients younger than 20 years, those aged 35 to 39 years had an odds ratio (OR) for stroke of 2.0 (95% CI 1.4–2.7, P<.01) and those older than or equal to 40 years had OR of 3.1 (95% CI 2–4.6).5 One study found that younger women, but not older women, had an increased stroke risk during pregnancy and the postpartum state.6 Pregnancy at older age may, however, have negative
Hemodynamic Changes
During pregnancy, there is a high metabolic demand. To account for this, cardiovascular changes occur to allow the maternal circulation to meet new physiologic requirements. One of the initial changes is an increase in the plasmatic volume beginning early in the first trimester, secondary to an increase in renin activity as stimulated by estrogen and other circulating hormones. There is also development of mild hemodilutional anemia, and substantial increases in heart rate and cardiac output,
Hypertensive Disorders of Pregnancy
HDP are a group of conditions occurring in pregnancy and puerperium with a common background of hypertension, defined as BP greater than or equal to 140/90 mm Hg. Included in this group are gestational hypertension, preeclampsia, severe preeclampsia (eclampsia and hemolysis, elevated liver enzymes, and low platelets syndrome), and chronic hypertension with superimposed preeclampsia. HDP are of clinical relevance, given their prevalence and strong risk of cardiovascular disease and stroke during
Acute Ischemic Stroke Management
For nonpregnant patients with acute ischemic stroke, early thrombolytic therapy and endovascular clot retrieval are the recommended hyperacute therapies to improve long-term clinical outcomes. However, these therapies have not been studied in randomized trials involving pregnant women. Further, this therapy is often withheld in many women, given concerns for life-threatening maternal and placental hemorrhages, including risk of fetal demise. The most widespread used thrombolytic, tissue
Morbidity and Mortality
Stroke morbidity is determined by the type of stroke, its severity, and therapies received for early management and secondary prevention. Mortality rates for stroke in pregnancy are reported at 2.7% to 20.4% and have not significantly changed over the past decades, despite advances in stroke treatment.1
Risk of Recurrent Stroke
For women of child-bearing age who have a stroke or VST, the risk of a recurrent stroke during pregnancy is not substantially high. A study of 441 women with a first ever stroke followed for
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