&
PREGNANCY
By Judith Barnaby, Stroke CNS
Reviewed by Dr. Bayer, Stroke
Neurologist, St. Michaels Hospital
Learning Objectives
To identify pertinent research statistics that pertain to
Statistics
Stroke is the second leading cause of death of
Statistics Contd:
Pregnancy related stroke in the UK: 11 to 26 deliveries per 100
000
Approx. 8% to 15% of pregnancy related stroke victims die
C-Section deliveries (3 to 12 times higher risk) than vaginal
deliveries
A study in the UK identified that thromboembolism was the
leading cause of maternal death (a study in the US: 5,723 cases
out of 8,918 cases were venous thrombosis in nature)
Most common cause of cerebral infarction: eclampsia and
preeclampsia.
Most common cause of intracerebral bleed: arterial aneurysm
and Arteriovenous malformation (AVM)
pregnancy
1. Marked increase in fibrinogen and factor VIII
(8). Factors VII (7), IX, X and XII are also
increased but to a lesser extend. Fibrinolytic
activity is depressed during pregnancy and
labour
2. Deep Vein Thrombosis (DVT) is a common
complication (1 to 2%; vaginal delivery and 2
to 10% for C-section delivery). Pulmonary
embolism is a potential complication
Hematological Disorders
Anemia may result from blood loss that
Pre-eclampsia
Pre-eclampsia is a form of pregnancy-associated
Gestational Diabetes
Gestational Diabetes is the inability of the
Post-Partum Period
In thromboembolic disease blood clots form in the
vessels.
This risk of developing thromboembolic disease is
increased for about 6 to 8 weeks after delivery.
Most complications results from injuries that occur
during delivery.
The risk is greater after a cesarean section than after
vaginal delivery
In one study (NEJM) the extremely high relative risk
of stroke during the postpartum period is likely the
result of a decrease in blood volume or the rapid
changes in hormonal status or the hemodynamic,
coagulative or vessel-wall changes
Race
Black women had the highest risk of stroke
age
The risk increased dramatically among
women aged 35 to 39 years (58.1 per 100,
000 deliveries)
The highest risk among women aged 40
years and older (90.5 per 100,000 deliveries)
Other
Cocaine abuse
Smoking
Hyperemesis
Transfusion
Cardiac
Management
Venous Thrombosis
Pregnant women: LMWH or unfractionated
Management contd:
Stroke and Pregnancy
Antiplatelet therapy
Heparin therapy
Thrombolysis (the safety of thrombolysis in
Case Study
See hand-out
Final Message
Although uncommon, the development of