Pregnancy-Related Stroke: A Review : Obstetrical & Gynecological Survey

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Pregnancy-Related Stroke: A Review

Doiron, Tucker MD; Ramseyer, Abigail DO; Phelps, Emily N. BS; Williams, Anne J. MNSc, APRN§; Teal, Linda N. MD; Hollenbach, Laura L. MD; Magann, Everett F. MD#

Author Information
Obstetrical & Gynecological Survey 77(6):p 367-378, June 2022. | DOI: 10.1097/OGX.0000000000001039



The maternal risk of strokes in the United States is approximately 30/100,000 pregnancies, and strokes are the eighth leading cause of maternal death. Because of the relationship between stroke and significant neurological disability/maternal death, obstetrical health care providers must be able to identify, evaluate, diagnosis, and treat these women.

Evidence Acquisition 

PubMed was searched using the search terms “stroke” OR “cerebrovascular accident” OR “intracranial hemorrhage” AND “pregnancy complications” OR “risk factors” OR “management” OR “outcome.” The search was limited to the English language and was restricted to articles from 2000 to 2020.


There were 319 abstracts identified, and 90 of the articles were ultimately used as the basis of this review. Presenting stroke signs and symptoms include headache, composite neurologic defects, seizures, and/or visual changes. Diagnosis is typically made with computed tomography scan using abdominal shielding or magnetic resonance imaging without contrast. Management options for an ischemic stroke include reperfusion therapy with intravenous recombinant tissue plasminogen activator catheter-based thrombolysis and/or mechanical thrombectomy. Hemorrhagic strokes are treated similarly to strokes outside of pregnancy, and that treatment is based on the severity and location of the hemorrhage.

Conclusions and Relevance 

Early recognition and management are integral in decreasing the morbidity and mortality associated with a stroke in pregnancy.

Relevance Statement 

This study was an evidence-based review of stroke in pregnancy and how to diagnose and mange a pregnancy complicated by a stroke.

Target Audience 

Obstetricians and gynecologist, family physicians

Learning Objectives 

After completing this learning activity, the participant should be better able to identify the pregnancy-related risk factors for a stroke; explain the presenting signs and symptoms of a stroke in pregnancy; describe the imaging modalities available to diagnose a stroke; and outline treatment options for an ischemic stroke and a hemorrhagic stroke.

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