Characteristics and treatment of stroke during pregnancy

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  • 妊婦の脳卒中における特徴と治療方法についての検討
  • ニンプ ノ ノウソッチュウ ニ オケル トクチョウ ト チリョウ ホウホウ ニ ツイテ ノ ケントウ

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Abstract

<p>  It is difficult to determine the appropriate treatment for stroke in pregnant women. We aimed to examine and analyze the background, treatment, and outcome of stroke in pregnant women. We retrospectively examined 15 cases of stroke, including 7 cases of intracerebral hemorrhage (ICH), 6 cases of subarachnoid hemorrhage (SAH), and 2 cases of ischemic stroke in pregnant women admitted to our hospital or related facilities. Of the 7 cases of ICH, 2 had cerebral arteriovenous malformation, 1 had cavernous hemangioma, and 1 had hemolysis, elevated liver enzymes, low platelet count (HELLP) syndrome. Direct surgery was performed in all 13 patients with either ICH or SAH, and endovascular surgery was performed for the 1 case of ischemic stroke. All of the 5 patients who developed stroke during the third trimester (after 28 weeks) underwent immediate cesarean section prior to neurosurgical treatment. We were able to save the lives of all infants, but two mothers died. The 7 patients who developed stroke before the third trimester (～28 weeks) underwent neurosurgical treatment prior to delivery, consequently saving the lives of all mothers and their infants. Out of the 13 patients with either ICH or SAH, the maternal outcome was good (mRS 0‒2) for 7 (54%). ICH led to poor maternal outcomes. In cooperation with the Department of Obstetrics, we suggest that, in order to achieve good outcomes, neurosurgical treatment is necessary for pregnant women with stroke, taking the method and timing of childbirth into consideration.</p>

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