Stroke in Pregnancy

Purpose of ReviewThis article will review current information about the epidemiology, risk factors, pathophysiology, management, and outcomes of conditions associated with maternal stroke.Recent FindingsPregnancy confers a substantially increased risk of stroke in women. The period of highest risk of stroke is the peripartum and 6-week post-partum period, coinciding with the highest risk for hypertensive disorders of pregnancy and peak gestational hypercoagulability. Physiological changes of pregnancy, including hypercoagulable states, venous stasis, and hemodynamic changes, are significant contributors to maternal stroke. However, hypertensive disorders of pregnancy carry the highest risk for obstetrical stroke and predispose women to premature cardiovascular disease. Newly identified risk factors for premature cardiovascular disease include additional adverse pregnancy outcomes. Hemorrhagic stroke is the most common type of obstetrical stroke. Ischemic stroke can result from cardiomyopathy, paradoxical embolism, posterior reversible encephalopathy, reversible cerebral vasoconstriction syndrome, and arterial dissections. Cerebral venous sinus thrombosis is a frequent complication of pregnancy. Acute ischemic stroke revascularization therapies such as intravenous thrombolysis with tissue plasminogen activator or endovascular thrombolysis clot retrieval appear safe during pregnancy and should not be withheld.SummaryPregnancy-associated stroke remains a significant cause of maternal morbidity and mortality, especially in the post-partum period, despite medical advances and organization of healthcare systems. It is imperative that obstetricians, primary care physicians, emergency physicians, and neurologists be aware of the risk factors, signs and symptoms of stroke, and the importance of its expedited management, with special attention to management of gestational and postpartum hypertension.