Timing and Risk Factors of Postpartum Stroke

Too, Gloria; Wen, Timothy; Boehme, Amelia K; Miller, Eliza C.; Leffert, Lisa; Attenello, Frank J.; Mack, William J.; D’Alton, Mary E.; Friedman, Alexander M.

doi:10.1097/aog.0000000000002372

Cited by 95 publications

(66 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our case report concerns with a rare presentation of a postpartum ischemic stroke occurring after the cesarean section. The risk of postpartum stroke is increased during the first year after delivery according to Cheng et al, with 58.4% cases occurring within 10 days postpartum [ 3 , 5 ]. The exact mechanism for increased risk in the postpartum period is unknown, but a rise in blood pressure on three to five days due to fluid shift and impaired cerebral autoregulation can increase the chances of stroke [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

“…The incidence is approximately between 11 and 26 per 100,000 deliveries, with the risk increasing in the postpartum period [ 1 , 2 ]. According to one study, the risk of postpartum stroke readmission was highest within 10 days of hospital discharge, with 58.4% cases occurring within 10 days [ 3 ]. Timely interventions and multidisciplinary collaboration among health care professionals are imperative in diagnosing and effectively managing such cases.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Postpartum Ischemic Stroke: A Rare Case

Farooque

Cheema

Karimi

et al. 2020

Cureus

View full text Add to dashboard Cite

The risk of stroke is increased during pregnancy and the postpartum period. It can lead to significant maternal morbidity and mortality. The physiologically mediated hemodynamic changes in circulation and vascular tissue, and the increased coagulability account for this increased risk of stroke. Pregnancy-related strokes can be hemorrhagic or ischemic. We present a rare case of postpartum ischemic stroke. A 25-year-old female with no known comorbidities and a history of cesarean section 10 days back presented with a right-sided weakness and sensory loss for one day. An MRI of the head revealed a large area of restricted diffusion on diffusion-weighted 1 (DW1) image in the left parietal region with comparable low signals on apparent diffusion coefficient (ADC) map and a small area of blooming suggesting hemorrhage on susceptibility-weighted 1 (SW1) image. This area appeared hypointense on T1 and hyperintense on fluid-attenuated inversion recovery (FLAIR) and T2 images. These findings suggested acute ischemic infarction. She was started on antiplatelet therapy, and subsequently, her weakness improved. She was discharged upon improvement in her symptoms and was asked to follow up in the outpatient department. Numerous studies have shown an increased risk of ischemic stroke in the immediate postpartum period in women who undergo a cesarean section. Thus, we conclude that clinicians should be aware of this complication and high-risk patients should be identified and monitored more aggressively in their immediate postpartum period.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Postpartum Ischemic Stroke: A Rare Case

Farooque

Cheema

Karimi

et al. 2020

Cureus

View full text Add to dashboard Cite

show abstract

“…1 The American College of Obstetricians and Gynecologists recommends close monitoring of patients with hypertensive disorders for the first 72 hours and again at 7e10 days after delivery, given the timing of peak blood pressures after delivery 2 and the need for optimal blood pressure management in this period of increased risk of stroke and seizure. 3 We previously showed that a text messageebased remote blood pressure monitoring program in the early postpartum period was more effective in obtaining these critical blood pressure values compared to in-person office visits in all at-risk women. 4 Non-Hispanic black women suffer a disproportionate amount of hypertensive-related morbidities and are 3 times more likely to die of preeclampsia than white women, 5 likely because of a combination of patient, community, provider, and systems factors.…”

Section: Objectivementioning

confidence: 98%

Text message remote monitoring reduced racial disparities in postpartum blood pressure ascertainment

Hirshberg

Sammel

Srinivas

2019

American Journal of Obstetrics and Gynecology

View full text Add to dashboard Cite

“…We used ICD-9-CM codes to identify comorbidities associated with arterial dissections and thrombosis during pregnancy: migraine, diabetes, and hypertensive disorders of pregnancy including pre-eclampsia and eclampsia. 6,[17][18][19][20] Additionally, we used previously validated ICD-9-CM codes 21 to identify ischemic stroke complicating cervical artery dissection.…”

Section: Measurementsmentioning

confidence: 99%

Association between Pregnancy and Cervical Artery Dissection

Omran

Parikh

Poisson

et al. 2020

Annals of Neurology

View full text Add to dashboard Cite

Objective We wanted to determine whether pregnancy is associated with cervical artery dissection. Methods We performed a case–control study using claims data from all nonfederal emergency departments and acute care hospitals in New York and Florida between 2005 and 2015. Cases were women 12–42 years of age hospitalized with cervical artery dissection, defined using validated diagnosis codes for carotid/vertebral artery dissection. Controls were women 12–42 years of age with a primary diagnosis of renal colic. Cases and controls were matched 1:1 on age, race, insurance, income, state, and visit year. The exposure variable was pregnancy, defined as labor and delivery within 90 days before or 6 months after the index visit. Logistic regression was used to compare the odds of pregnancy between cases and controls. We performed a secondary cohort‐crossover study comparing the risk of cervical artery dissection during pregnancy versus the same time period 1 year later. Results Pregnancy was twice as common among 826 women with cervical artery dissection compared with the 826 matched controls with renal colic (odds ratio, 2.5; 95% confidence interval [CI], 1.3–4.7). In our secondary analysis, pregnancy was associated with a higher risk of cervical artery dissection (incidence rate ratio [IRR], 2.2; 95% CI, 1.3–3.5), with the heightened risk limited to the postpartum period (IRR, 5.5; 95% CI, 2.6–11.7). Interpretation Pregnancy, specifically the postpartum period, was associated with hospitalization for cervical artery dissection. Although these findings might in part reflect ascertainment bias, our results suggest that arterial dissection is one mechanism by which pregnancy can lead to stroke. ANN NEUROL 2020;88:596–602

show abstract

Timing and Risk Factors of Postpartum Stroke

Cited by 95 publications

References 32 publications

Postpartum Ischemic Stroke: A Rare Case

Postpartum Ischemic Stroke: A Rare Case

Text message remote monitoring reduced racial disparities in postpartum blood pressure ascertainment

Association between Pregnancy and Cervical Artery Dissection

Contact Info

Product

Resources

About