Intracranial haemorrhage in pregnancy

Abstract

Summary: Intracranial haemorrhage (ICH) is a rare, yet potentially devastating event in pregnancy. There is a risk of maternal mortality or morbidity and a significant risk to the unborn child. The risk of haemorrhage increases during the third trimester and is greatest during parturition and the puerperium. ICH can be extradural, subdural, subarachnoid or intraparenchymal. Causes of bleeding include trauma, arteriovenous malformations, aneurysms, preeclampsia/eclampsia and venous thrombosis. Urgent neurosurgical conditions generally outweigh obstetric considerations in management decisions, although anaesthetic and surgical modifications can be made to minimize adverse effects to the fetus.

Clinical Reasoning: Acute onset facial droop in a 36-year-old pregnant woman

“…Several studies have reported vascular anomalies as the most common etiology of ICH in pregnancy. 1,5 Although the changed hemodynamics of pregnancy, including increased blood volume and venous blood pressure, suggest increased risk of aneurysmal rupture or AVM bleeding, the literature is divided on whether this theoretical risk manifests clinically. 2,4 Cavernous malformations may enlarge, but are not a high-flow system (unlike AVMs), and have not shown increased risk of bleeding.…”

“…2,4 Cavernous malformations may enlarge, but are not a high-flow system (unlike AVMs), and have not shown increased risk of bleeding. 5 Ischemic stroke etiologies include those common in the nonpregnant population: cardioembolic, artery-to-artery thromboembolism, arterial dissection, and hypercoagulable disorders. 4 Preeclampsia and eclampsia are important risk factors for both ischemic and hemorrhagic stroke.…”

Preeclampsia and stroke

“…Ча-стота ОНМК в III триместре, в родах и в послеродо-вом периоде, по данным литературы [11], увеличива-ется. По данным нашего исследования [12], в 64,7% случаев ОНМК развивалось в III триместре, в родах и в послеродовом периоде.…”

Neurosurgical Issues in Pregnancy

“…2 Changes in vascular physiology and blood volume during pregnancy may account for the increased risk of hemorrhage. 3 Blood volume increases by 50% during pregnancy and reaches a plateau at 32 weeks gestation. 3 Accordingly, cardiac output increases by 50% during the first stage of labor compared with prepregnancy baseline, although the effects of this transient but substantial increase on ICH risk are unknown.…”

“…3 Blood volume increases by 50% during pregnancy and reaches a plateau at 32 weeks gestation. 3 Accordingly, cardiac output increases by 50% during the first stage of labor compared with prepregnancy baseline, although the effects of this transient but substantial increase on ICH risk are unknown. 4 In a retrospective analysis of 50,700 admissions for delivery, intracranial hemorrhage was identified as the cause of 13 of the 34 identified strokes.…”