Stroke during pregnancy and puerperium among Japanese women: a single-center registry

Abstract

Background

Stroke is one of the major causes of maternal death. This study aimed to analyze the maternal and fetal outcomes of stroke occurred during pregnancy and puerperium.

Methods

We conducted a retrospective analysis of patients admitted to our perinatology center between 1982 and 2012 with a diagnosis of acute cerebral stroke during pregnancy or within 6 weeks postpartum.

Results

Thirty-four patients were registered and all the patients had never been diagnosed as stroke nor detected cerebrovascular abnormalities before the current pregnancies. They were divided into 8 ischemic strokes (ISs) and 26 intracranial hemorrhage group. In the hemorrhage group, there was a spontaneous abortion and two patients chose artificial abortions to avoid rehemorrhage, and there were another three intrauterine fetal deaths (IUFDs) in the acute stage of maternal stroke. More patients in hemorrhage group delivered in preterm than in IS group for the treatment of stroke, 10/23 (43%) versus 0/8 (0%), p < .05. More patients in hemorrhage group had low Glasgow Coma Scale (GCS) (3–8) than in IS group at the onset of the stroke, 12/26 (46%) versus 0/8 (0%), p < .05. There were three maternal deaths and 6/23 (26%) were neurologically dependent in hemorrhage group in the chronic stage, whereas 87% were independent in IS group, p < .05.

Conclusions

Hemorrhagic stroke was more common etiology of stroke related to pregnancy than IS in this study. Intensive and multidisciplinary care was needed especially in hemorrhagic stroke related to pregnancy as in the hemorrhagic stroke the fetal survival rate was lower, and maternal conscious levels at the onset of the stroke and neurological outcomes in the chronic stage were worse than IS.

Keywords:

• Hemorrhagic stroke
• ischemic stroke
• pregnancy

Acknowledgments

Authors thank to the staff of National Cerebral and Cardiovascular Center for editorial preparation.

Details of ethics approval

This study was exempted from Committee on Human Research approval (National Cerebral and Cardiovascular Center) because there no longer exists a key or code sheet relating the individual’s identities to their private health information. This investigation was conducted according to the principles expressed in the Declaration of Helsinki. Informed consent was not obtained from patients or their families, because this study was based on the analysis of institutional forms, and the patient records/information was anonymized prior to the analysis.

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Disclosure statement

No potential conflict of interest was reported by the authors.