Pregnancy and stroke risk in women

Abstract

Stroke associated with pregnancy and post-partum occurs in about 30 per 100,000 deliveries, and includes subtypes of ischemic and hemorrhagic stroke as well as cerebral venous sinus thrombosis (CVST). There are a wide variety of underlying causes and risk factors, some that are common to both pregnant and non-pregnant women, and others that are unique to pregnancy. Although some of the strokes that occur may be a direct result of the pregnancy itself, such as hypertensive disorders of pregnancy, others could be anticipated or prevented by understanding the risk factors. These may include the presence of pre-pregnancy clotting disorders, aneurysms or arteriovenous malformations, hypertension, diabetes, or advanced maternal age. Treatment of stroke during pregnancy is based on the current recommendations for non-pregnant stroke patients, assuming the benefit of these treatments is likely higher than the risks. These decisions must be made with the appropriate specialists in stroke and endovascular treatment, as well as high-risk obstetrician/gynecologists, and most importantly, patient and family preferences.

Keywords: Cerebral venous sinus thrombosis; Pre-eclampsia; Pregnancy; Stroke.

Fig. 1.

Coagulation cascade. The classical coagulation cascade consists of two initial pathways, the intrinsic pathway and the extrinsic pathway, which lead to fibrin formation as a product of the common pathway. The figure shows the activations of the various proteases and glycoproteins that lead to the generation of the cross-linked fibrin clot. The red dotted lines depict inhibitory functions, and the green dotted lines depict positive feedback reactions, both of which could lead to either excess bleeding or clotting, if unbalanced. TFPI indicates tissue factor pathway inhibitor. Widipedia.org Accessed April 3, 2022. https://en.wikipedia.org/wiki/GNU_Free_Documentation_License