Peripartum Subarachnoid Hemorrhage

Bateman, Brian T.; Olbrecht, Vanessa A.; Berman, Mitchell F.; Minehart, Rebecca D.; Schwamm, Lee H.; Leffert, Lisa

doi:10.1097/aln.0b013e3182410b22

Cited by 86 publications

(26 citation statements)

References 32 publications

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“…10,11,24,26 The mortality rate from our study for postdischarge hemorrhagic events was approximately 1.5 times greater than that for ischemic events, which is also supported by previous literature comparing pregnancy-related ischemic and hemorrhagic strokes. 25,29 Several risk factors, including eclampsia, preeclampsia, black race, and older age, were common to both ischemic and hemorrhagic postdischarge acute CVD.…”

Section: Discussionsupporting

confidence: 90%

“…In addition, hypertension, which is part of the eclampsia syndrome and a major risk factor for posterior reversible encephalopathy syndrome, has been found in multiple prior studies to be a significant risk factor for postpartum acute CVD. 2,4,13,24-28 Although we cannot establish a causal relationship between postdischarge acute CVD and the risk factors we identified, these risk factors may be helpful in identifying patients at high risk of CVD after discharge who may potentially benefit from close monitoring and targeted efforts at risk factor modification.…”

Section: Discussionmentioning

confidence: 90%

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Acute Cerebrovascular Disease Occurring After Hospital Discharge for Labor and Delivery

Hovsepian

Sriram

Kamel

et al. 2014

Stroke

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Background and Purpose The risk of stroke and other postpartum cerebrovascular disease (CVD) occurring after hospital discharge for labor and delivery is uncertain. Methods We performed a retrospective cohort study using administrative databases to identify all pregnant women who were hospitalized for labor and delivery at nonfederal, acute care hospitals in California from 2005 through 2011 and who were discharged without an International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis of CVD. The primary outcome was an acute CVD composite defined as any ischemic stroke, intracranial hemorrhage, cerebral venous sinus thrombosis, pituitary apoplexy, carotid/vertebral artery dissection, hypertensive encephalopathy, or other acute CVD occurring after hospital discharge and prior to 6 weeks after labor and delivery. Descriptive statistics were used to estimate the incidence of postdischarge CVD. Multivariate logistic regression was used to evaluate the association between selected baseline factors and postdischarge CVD. Results The rate of any postdischarge acute CVD was 14.8 per 100,000 patients (95% CI 13.2-16.5). Risk factors for any acute CVD were eclampsia (OR 10.1, 95% CI 3.09-32.8), chronic kidney disease (OR 5.4, 95% CI 2.5-11.8), black race (OR 2.5, 95% CI 1.9-3.3), preeclampsia (OR 2.1, 95% CI 1.6-2.8), pregnancy-related hematologic disorders (OR 1.8, 95% CI 1.3-2.5), and age (OR 1.5 per decade, 95% CI 1.3-1.8). Conclusion The incidence of postpartum acute CVD after hospital discharge for labor and delivery is similar to rates reported for all postpartum events in prior publications, suggesting that a substantial proportion of postpartum CVD occurs after discharge.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 90%

Acute Cerebrovascular Disease Occurring After Hospital Discharge for Labor and Delivery

Hovsepian

Sriram

Kamel

et al. 2014

Stroke

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“…Pre‐eclampsia was also associated with a long‐term risk of intracerebral hemorrhage in a retrospective cohort study in Taiwan [30]. Hypertensive disorders were important independent risk factors for pregnancy‐related SAH in a cohort study in the United States, however, that study included SAH etiologies other than aneurysm rupture [31]. The risk of aSAH was not increased during pregnancy, labor or the puerperium, according to a case‐crossover study in Utrecht [32].…”

Section: Discussionmentioning

confidence: 99%

Pre‐eclampsia, gestational diabetes and hypertensive disorders in patients with intracranial aneurysms: A case–control study

Kotikoski

Kurtelius

Nurmonen

et al. 2021

Euro J of Neurology

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Background and purpose:The aim of this study was to define the prevalence of preeclampsia, gestational hypertension (HT), chronic HT, and gestational diabetes during pregnancy in a defined population of patients with saccular intracranial aneurysms (sIAs). Methods:We included all patients with sIA, first admitted to the Neurosurgery Department of Kuopio University Hospital from its defined catchment population between 1990 and 2015, who had given birth for the first time in 1990 or later. The patients' medical records were reviewed, and clinical data were linked with prescription drug usage, hospital diagnoses and causes of death, obtained from nationwide registries.The prevalences of pre-eclampsia, other hypertensive disorders and gestational diabetes in patients were compared with a matched control population (n = 324). In addition, the characteristics of sIA disease in patients with pre-eclampsia were compared to those of sIA patients without pre-eclampsia.Results: A total of 169 patients with sIA fulfilled the inclusion criteria. Of these, 22 (13%) had pre-eclampsia and 32 (19%) had other hypertensive disorders during pregnancy.In 324 matched controls who had given birth, the prevalence of pre-eclampsia was 5% (n = 15) and other hypertensive disorders were diagnosed in 10% (n = 34). There was no significant difference in prevalence of gestational diabetes (12% vs. 11%). Patients with sIA with pre-eclampsia more frequently had irregularly shaped aneurysms (p = 0•003).Conclusions: Pre-eclampsia was significantly more frequent in patients with sIA than in their population controls. Irregularly shaped aneurysms were more frequent in sIA patients with pre-eclampsia. Further studies are required to determine whether history of pre-eclampsia may indicate an elevated risk for sIA formation or rupture.

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“…[96] The etiologies of SAH in pregnancy are diverse and include ruptured saccular and mycotic aneurysms, ruptured arteriovenous malformations, intracranial venous thrombosis, pregnancy-induced hypertension leading to pial vessel rupture, intracranial vertebral artery dissection, Moyamoya disease, posterior reversible encephalopathy syndrome, and postpartum angiopathy, which is a form of the reversible cerebral vasoconstriction syndrome. [97] Mostly, pregnancyrelated SAH are caused by aneurysmal rupture or bleeding from a vascular malformation. [98] Due to the increased vascular stress from expanded circulating blood volume and increased cardiac output, aneurysmal SAH is most commonly reported in the third trimester, and up to 6 weeks postpartum period.…”

Section: D) Reversible Cerebral Vasoconstriction Syndrome (Rcvs)mentioning

confidence: 99%

Headache in Challenging and Special Circumstances: Pregnancy and Lactation

Yılmaz¹,

Çevik

2018

Agri

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ÖzetGebelik ve doğum sonrası dönemdeki baş ağrıları özel bir önem taşımaktadır. Bu dönemdeki baş ağrısı yönetimi sağlık çalışanları ve hastalar tarafından zorlayıcı olarak bildirilmektedir. Başağrısına doğru yaklaşım hem anne hem de fetal/yenidoğan risklerinin önlenmesi açısından önemlidir. İlk trimesterdeki baş ağrılarının büyük çoğunluğu primer baş ağrıları grubundadır. Gebeliğin son trimesteri ve doğum sonrası dönemlerde, sekonder baş ağrılarının sıklığı ise artmaktadır. Baş ağrısı hastalarında kırmızı bayrak belirti ve bulgularına dikkat edilmelidir. Baş ağrısı hastasının değerlendirilmesinde detaylı anamnez alınması; doğru ve eksiksiz olarak fizik ve nörolojik muayene yapılması yanında gerekirse ileri tetiklerin yapılması da önemlidir. Bu derlemede gebelik ve laktasyon dönemindeki baş ağrılarına yaklaşım ve en iyi medikal uygulama stratejileri gözden geçirilmektedir. Anahtar sözcükler: Tanı; migren; primer baş ağrıları; kırmızı bayrak bulguları; sekonder baş ağrıları; tedavi. SummaryHeadache has special importance during pregnancy and postpartum period. The health-care professionals and patients report headache management as challenging during pregnancy and lactation period. Cautions are recommended in preganancy and lactation due to maternal and fetal/newborn risks. Most headaches in the first trimester are due primary headaches. Nevertheless, the incidence of secondary headaches increase in the last trimester and post-partum period. Red flags prompt early evaluation in a patient with headache. Assessment of headache patient requires a detailed history of the headache characteristics and performing appropriate examinations. Approach to headache and strategies to promote best practice in preganancy and lactation will be reviewed.

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Peripartum Subarachnoid Hemorrhage

Abstract: SAH during pregnancy results from a range of etiologies, and is less likely to be because of a cerebral aneurysm than SAH occurring in the nonpregnant patient. Peripartum SAH frequently occurs in the setting of hypertensive disorders.

Cited by 86 publications

References 32 publications

Acute Cerebrovascular Disease Occurring After Hospital Discharge for Labor and Delivery

Acute Cerebrovascular Disease Occurring After Hospital Discharge for Labor and Delivery

Pre‐eclampsia, gestational diabetes and hypertensive disorders in patients with intracranial aneurysms: A case–control study

Headache in Challenging and Special Circumstances: Pregnancy and Lactation

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