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Stroke during pregnancy and pre-eclampsia

Crovetto, Francescaa,b; Somigliana, Edgardoa,c; Peguero, Annab; Figueras, Francescb

Current Opinion in Obstetrics & Gynecology: December 2013 - Volume 25 - Issue 6 - p 425–432
doi: 10.1097/GCO.0000000000000024
WOMEN'S HEALTH: Edited by Joseph Aquilina

Purpose of review: Stroke is a life-threatening condition whose frequency is increased during pregnancy, in particular in the two first weeks of the puerperium. Pre-eclampsia/eclampsia is a disorder that enhances this risk. The purpose of this review is to summarize existing data regarding the association, diagnosis as well as management for stroke in pre-eclampsia or eclampsia.

Recent findings: In about one third of stroke cases during pregnancy or puerperium, pre-eclampsia or eclampsia is concomitantly diagnosed. In these women, hemorrhagic stroke is more common than ischemic stroke, probably as a result of severe hypertension. Clinical presentation may vary but severe headache is the most common symptom. Neuroimaging techniques are warranted to identify affected cases. Prevention is based on blood pressure adjustment and thromboprophylaxis.

Summary: The risk of stroke should be taken into consideration in women with a diagnosis of pre-eclampsia or eclampsia. In particular, women with neurologic symptoms should be promptly evaluated, blood pressure should be adjusted and thromboprophylaxis should be started.

aDepartment of Obstetrics and Gynecology, Fondazione Ca’ Granda, Ospedale Maggiore Policlinico; Università degli Studi di Milano, Milan, Italy

bDepartment of Maternal-Fetal Medicine, Institute Clínic of Gynecology, Obstetrics and Neonatology (ICGON), Hospital Clinic-IDIBAPS, University of Barcelona and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain

cInfertility Unit, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy.

Correspondence to Francesca Crovetto, MD, Department of Obstetrics and Gynecology, Fondazione Ca’ Granda, Ospedale Maggiore Policlinico, via Commenda 12, 20122 Milano, Italy. Tel: +39 34 6082204; e-mail: franci.crovetto@gmail.com

© 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins