Pregnancy and Stroke

Abstract

The risks of ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage are not increased in the 9 months of gestation except for a high risk in the 2 days prior and 1 day postpartum. The remaining 6 weeks postpartum also have an increased risk of ischemic stroke and intracerebral hemorrhage, though less than the peripartum period. Although there are some rare causes of stroke specific to pregnancy and the postpartum period, eclampsia, cardiomyopathy, postpartum cerebral venous thrombosis, and, possibly, paradoxical embolism warrant special consideration. The diagnostic and therapeutic approaches to stroke during pregnancy and the postpartum period are similar to the approaches in the nonpregnant woman with some minor modifications based on consideration of the welfare of the fetus. There is a theoretical risk of magnetic resonance imaging exposure during the first and second trimester but the benefit to the mother of obtaining the information may outweigh the risk. Available evidence suggests that low-dose aspirin (<150 mg/day) during the second and third trimesters is safe for both mother and fetus. Postpartum use of low-dose aspirin by breast-feeding mother is also safe for infant. While proper counseling is imperative, a history of pregnancy-related stroke should not be a contraindication for subsequent pregnancy.

Stroke in the Postpartum Period: A Case Study

“…In terms of secondary prevention, despite limited research and data, some studies have recommended the use of low dose aspirin (75mg once daily) in breast feeding mothers [8]. Our patient was advised not to breast feed.…”

Subarachnoid Hemorrhage from Posterior Cerebral Artery Aneurysm during Puerperium – Case Report and Review of Literature

“…10% of all maternal deaths in the UK with spontaneous SAH [5] and Barno and Freeman [10] found 4.4 % of all maternal deaths between 1950 and 1973 in Minnesota directly linked to SAH. Some authors emphasized an increased risk of stroke and SAH during the first six weeks post-delivery [2,6], particularly concerning women with peripartum cerebral venous thrombosis and preeclampsia-eclampsia [3,7].…”

“…In an epidemiological survey Jung et al [1] investigated a history of hypertension and diabetes, a family history of stroke, smoking status and alcohol consumption as potential confounders of hemorrhagic stroke in 471 women with parity. Particularly pregnant women, suffering from preeclampsia-eclampsia or cardiomyopathy are at high risk [3,6,7]. Some authors suggested transient degeneration and turnover of the vessel wall -presumably based on hormonal changes -in combination with postpartum or pregnancy-related hypertension as potential causes of aneurysm formation and rupture [1,2,4,6,7].…”

“…Particularly pregnant women, suffering from preeclampsia-eclampsia or cardiomyopathy are at high risk [3,6,7]. Some authors suggested transient degeneration and turnover of the vessel wall -presumably based on hormonal changes -in combination with postpartum or pregnancy-related hypertension as potential causes of aneurysm formation and rupture [1,2,4,6,7]. Due to our knowledge, spontaneous SAH due to an aneurysm of the quadrigeminal (P3-) segment of the Posterior Cerebral Artery (PCA) during puerperium has not been reported yet.…”

Peripartum Cardiomyopathy: A Systematic Review

“…Some case series describe unusual presentations such as acute cyanosis (Cole et al, 2001), multiple thromboembolic events (Carlson et al, 2000) or liver failure (Fussell et al, 2005). Systemic and pulmonary embolic episodes are found during the clinical course of PPCM more frequently than in patients with other forms of cardiomyopathy (Bennani, 2003;Box, 2004;Helms & Kittner, 2005;Jha, 2005;LasinskaKowara, 2001). Sudden dyspnea, pleuritic pain, and hemoptysis suggest an episode of pulmonary embolism.…”