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Pregnancy Stroke Risk Highest In Third Trimester Or Postpartum
A DGReview of :"Stroke and Pregnancy"
Stroke
12/08/2000
By Anne MacLennan
Most pregnancy-related strokes are arterial occlusions, and most occur during the third trimester and puerperium, a study has found.
This study sought to characterize subtypes of stroke linked with pregnancy and puerperium, with particular reference to timing, etiology, risk factors and outcome.
A retrospective analysis was performed of patients admitted to a single large hospital over a 17-year period with a diagnosis of stroke during pregnancy or within six weeks postpartum.
Strokes were classified as ischemic (arterial or venous) or hemorrhagic (subarachnoid or intracerebral). All patients were investigated with at least a computed tomography scan of the head; most also had MRI and/or cerebral angiography.
Of 50,700 admissions for delivery in the study period, 34 women were identified with a stroke diagnosis -- 21 infarctions and 13 hemorrhages.
Thirteen of the infarctions were arterial and eight were venous. Nine of 13 arterial events occurred in the third trimester or puerperium; seven of eight venous occlusions occurred postpartum.
An etiologic diagnosis was made in seven of 13 patients with arterial territory infarction, including cardiac emboli, coagulopathies and carotid artery dissection.
Among the patients with hemorrhage, seven were subarachnoid and six were intracerebral. In ten of the women, etiology was identified. Three were due to ruptured aneurysms, five were linked with arteriovenous malformations and two were associated with disseminated intravascular coagulation.
Although all patients with infarction survived, three with hemorrhage died.
"Stroke and Pregnancy"
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