PRENATAL STROKE – An overview

By avn
10:39 am Posted November 19, 2016
In Stroke

Postpartum period and pregnancy are closely associated with the risk of an Ischemic Stroke and Intracerebral hemorrhage. There are several causative factors that are unique to pregnancy and the postpartum period, such as preeclampsia and eclampsia, amniotic fluid embolus, postpartum angiopathy and postpartum cardiomyopathy.

Risk factors of Stroke related to Pregnancy

  • The increasing prevalence of obesity is a significant risk factor of stroke during pregnancy in young age.
  • Other pre-existing ailments such as diabetes, valvular disease, hypercoagulable disorders, sickle cell disease, lupus also increase the risk.
  • Abuse of tobacco and other substances.
  • Hypertension in pregnancy is a potential risk factor for developing a stroke during pregnancy.
  • Caesarian Delivery is associated with Post partum stroke and maybe a risk factor for stroke due to cerebral venous thrombosis(clot formation in the venous system)
  • Age is also an important factor to consider. The risk of stroke is two-fold in women above 35 years of age.

Complications in Pregnancy leading to a stroke:

    • Hyper-coagulability

Hypercoagulability refers to the tendency of developing blood clots, also known as thrombosis. Pregnancy by itself is a hypercoagulable stage to prevent post partum bleeding. However, in conjunction with pre-existing factors of hypercoagulability, it may lead to deep venous thrombosis causing maternal death after bleeding. Antiphospholipid syndrome is associated with adverse pregnancy condition such as recurrent miscarriage. Other factors include Protein C and S deficiencies, Antithrombin III deficiency, Prothrombin mutation.

    • Preeclampsia

This is a condition that occurs only during pregnancy. Preeclampsia is often precluded by hypertension during gestational period. It is a serious condition characterized by development of high blood pressure, edema (swelling) and protein in urine. Women may complain of blurred vision, headaches and experience greater than normal weight gain. This occurs

  • To a first time mom
  • When a woman has multiple babies
  • When the mother or her sister has preeclampsia
  • In Obese women
  • In Women who are younger than 20 and older than 40 years of age

Treatment Process

The treatment process is a controversial one. More research is necessary to develop guidelines for appropriate preventive and acute treatment of stroke in pregnancy, since there is very limited information available regarding the safety and efficacy of commonly used drugs, such as aspirin, TPA etc.

In cases of hypercoagulability led complications , anti-coagulants are used. However, any anticoagulant drug must be used with caution in women who are suspected with coagulopathy, thrombocytopaenia, liver disease and nephropathy. Major side effects are osteoporosis, thrombocytpaenia, drug allergy, hair loss and hemorrhage. Platelet count has to be checked before and after commencing anticoagulant therapy to diagnose symptoms of thrombocytopaenia within 7 -10 days and a month later.

When the Preeclampsia starts setting in and is mild, it is recommended that the expectant mother follow the below:

  • Always rest on the left side. This shifts the weight of the baby off the major blood vessels.
  • Consume less salt.
  • Regular prenatal checkups
  • Drink at least 8 glasses of water every day
  • Include more protein in the diet.

The treatment plan differs for each condition depending on how close the due date is and if an early delivery is advisable to avoid complications. Most doctors advocate cesarean delivery after careful consideration of the hemodynamic parameters in mother and fetus.

Prevention

Occurrence of Stroke during pregnancy, after birth, before birth as per a study reveals equal proportion in all the cases. Listed below are some preventive measures to overcome the risk of Stroke during pregnancy.

  • Regular physical activity
  • Healthy diet
  • Control of weight
  • Control in Blood pressure, sugar and Cholesterol levels
  • Avoid Smoking

Women suffering from pre-existing ailments such as heart diseases or diabetes should consult their physician and establish a treatment plan during the very initial stages of pregnancy and carefully monitor their health all through the pregnancy.

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