Neurol. praxi. 2021;22(6):489-495 | DOI: 10.36290/neu.2021.090

Ischemic stroke during pregnancy and puerperium

MUDr. Stanislava Jakubíček, Ph.D., MUDr. Michal Reif
1. neurologická klinika, Fakultní nemocnice u sv. Anny v Brně a Lékařská fakulta Masarykovy univerzity v Brně

Despite the rare occurrence of ischemic stroke in pregnancy and puerperium, the incidence of this disease is rising with the increasing prevalence of obesity, hypertension and cardiac disease among women of childbearing age (James et al., 2005). Ischemic stroke in pregnant women has specific etiological, diagnostic and therapeutic aspects. The purpose of this article is to address these aspects of ischemic stroke in pregnant women in greater detail, so that patient care for mother and fetus are approached safely and effectively at the same time.

Keywords: ischemic stroke, pregnancy, intravenous thrombolysis, mechanical thrombectomy and secondary prevention.

Received: October 18, 2021; Revised: October 18, 2021; Accepted: November 9, 2021; Prepublished online: November 9, 2021; Published: December 9, 2021  Show citation

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Jakubíček S, Reif M. Ischemic stroke during pregnancy and puerperium. Neurol. praxi. 2021;22(6):489-495. doi: 10.36290/neu.2021.090.
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References

  1. Aaron S, Shyamkumar NK, Alexander S, Babu PS, Prabhakar AT, Moses V, Murthy TV, Alexander M. Mechanical thrombectomy for acute ischemic stroke in pregnancy using the penumbra system. Ann Indian Acad Neurol 2016; 19: 261-263. Go to original source... Go to PubMed...
  2. Ascoli Marchetti A, Diomedi M, Ascoli Marchetti S, Piccione E, Ippoliti A. Ischemic stroke and floating thrombosis in dissection of the common carotid artery in patient at third week of pregnancy: Surgical technical success and maintenance of pregnancy. SAGE Open Medical Case Reports. 2019; 7: 2050313X19831117. Go to original source... Go to PubMed...
  3. Bhogal P, Aguilar M, AlMatter M, Karck U, Bäzner H, Henkes H. Mechanical Thrombectomy in Pregnancy: Report of 2 Cases and Review of the Literature. Intervent Neurol 2017; 6: 49-56. Go to original source... Go to PubMed...
  4. Blythe R, Ismail A, Naqvi A. Mechanical thrombectomy for acute ischemic stroke in pregnancy. Journal of Stroke and Cerebrovascular Diseases 2019; 28: e75-e76. Go to original source... Go to PubMed...
  5. Bona G, Zaffaroni M, Defilippi C, Gallina MR, Mostert M. Effects of iopamidol on neonatal thyroid function. Eur J Radiol 1992; 14: 22-25. Go to original source... Go to PubMed...
  6. Bremme KA. Haemostatic changes in pregnancy. Best Pract Res Clin Haematol. 2003; 16(2): 153-68. Go to original source... Go to PubMed...
  7. Brenner B. Haemostatic changes in pregnancy. Thromb Res 2004; 114(5-6): 409-414. Go to original source... Go to PubMed...
  8. Bushnell C, McCullough LD, Awad IA, Chireau MV, Fedder WN, Furie KL, Howard VJ, Lichtman JH, Lisabeth LD, Piña IL, Reeves MJ, Rexrode KM, Saposnik G, Singh V, Towfighi A, Vaccarino V, Walters MR; American Heart Association Stroke Council; Council on Cardiovascular and Stroke Nursing; Council on Clinical Cardiology; Council on Epidemiology and Prevention; Council for High Blood Pressure Research. Guidelines for the prevention of stroke in women: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2014; 45: 1545-1588. Go to original source... Go to PubMed...
  9. Caso V, Falorni A, Bushnell CD, Acciarresi M, Remohí J, Sprigg N, Gerli S. Pregnancy, Hormonal Treatments for Infertility, Contraception, and Menopause in Women After Ischemic Stroke: A Consensus Document. Stroke 2017; 48(2): 501-506. Go to original source... Go to PubMed...
  10. Clark SL, Hankins GDV, Dudley DA, Dildy GA, Porter TF. Amniotic fluid embolism: Analysis of the national registry. American journal of obstetrics and gynecology 1995; 172(4): 1158-1169. Go to original source... Go to PubMed...
  11. COG Committee Opinion No. 743: Low-Dose Aspirin Use during Pregnancy. Obstet Gynecol 2018; 132(1): e44-e52. Go to original source... Go to PubMed...
  12. Copel J, El-Sayed Y, Heine RP, Wharton KR. American College of Obstetricians and Gynecologists' Committee on Obstetric Practice. Committee Opinion No. 723: Guidelines for Diagnostic Imaging during Pregnancy and Lactation. Obstet Gynecol 2017; 130(4): e210-216. Go to original source... Go to PubMed...
  13. Del Zotto E, Giossi A, Volonghi I, Costa P, Padovani A, Pezzini A. Ischemic stroke during pregnancy and puerperium. Stroke Research Treatment 2011; 2011: 606780. Go to original source... Go to PubMed...
  14. Elkayam U, Akhter MW, Singh H, Khan S, Bitar F, Hameed A, Shotan A. Pregnancy associated cardiomyopathy: clinical characteristics and a comparison between early and late presentation. Circulation 2005; 111(16): 2050-2055. Go to original source... Go to PubMed...
  15. Heinrichs WL, Fong P, Flannery M, Heinrichs SC, Crooks LE, Spindle A, Pedersen RA. Midgestational exposure of pregnant BALB/c mice to magnetic resonance imaging conditions. Magn Reson Imaging 1988; 6(3): 305-313. Go to original source... Go to PubMed...
  16. Hunter S, Robson SC. Adaptation of the maternal heart in pregnancy. Br Heart J 1992; 68(6): 540-543. Go to original source... Go to PubMed...
  17. Hypertension in pregnancy. Report of the American College of Obstetricians and Gynecologists' Task Force on Hypertension in Pregnancy. Obstet Gynecol 2013; 122(5): 1122-1131.
  18. Chen L, Deng W, Palacios I, Inglessis-Azuaje I, McMullin D, Zhou D, Lo EH, Buonanno F, Ning M. Patent foramen ovale (PFO), stroke and pregnancy. J Investig Med 2016; 64(5): 992-1000. Go to original source... Go to PubMed...
  19. Ilancheran A, Ratnam S, Baratham, G. Metastatic cerebral choriocarcinoma with primary neurological presentation. Gynecologic Oncology 1998; 29: 361-364. Go to original source... Go to PubMed...
  20. James AH, Bushnell CD, Jamison MG, Myers ER. Incidence and risk factors for stroke in pregnancy and the puerperium. Obstet Gynecol 2005; 106(3): 509-516. Go to original source... Go to PubMed...
  21. Kamel H, Navi BB, Sriram N, Hovsepian DA, Devereux RB, Elking MS. Risk of a thrombotic event after the 6-week postpartum period. N Engl J Med 2014; 370: 1307-1315. Go to original source... Go to PubMed...
  22. Karalis DG, Hill AN, Clifton S, Wild RA. The risks of statin use in pregnancy: A systematic review. J Clin Lipidol 2016; 10(5): 1081-1090. Go to original source... Go to PubMed...
  23. Khalid A, Hadbavna A, Williams D, Byrne B. A review of stroke in pregnancy: incidence, investigations and management. Obstet Gynecol. 2020; 22: 21-33. Go to original source...
  24. Kubik-Huch RA, Gottstein-Aalame NM, Frenzel T, Seifert B, Puchert E, Wittek S, et al. Gadopentetate dimeglumine excretion into human breast milk during lactation. Radiology 2000; 216: 555-558. Go to original source... Go to PubMed...
  25. Leffert LR, Clancy CR, Bateman BT, Cox M, Schulte PJ, Smith EE, Fonarow GC, Kuklina EV, George MG, Schwamm LH. Treatment patterns and short-term outcomes in ischemic stroke in pregnancy or postpartum period. AM J Obstetr Gynecol 2016; 214(6): 723.e1-723.e11. Go to original source... Go to PubMed...
  26. Magin RL, Lee JK, Klintsova A, Carnes KI, Dunn F. Biological effects of long-duration, high-field (4 T) MRI on growth and development in the mouse. J Magn Reson Imaging 2000; 12(1): 140-9. Go to original source...
  27. Morisetti A, Tirone P, Luzzani F, de Haën C. Toxicological safety assessment of iomeprol, a new X-ray contrast agent. Eur J Radiol 1994; 18(Suppl. 1): S21-31. Go to original source... Go to PubMed...
  28. Neumann J, Tomek A, Školoudík D, Škoda O, Mikulík R, Herzig R, Václavík D, Bar M, Šaňák D. Doporučený postup pro intravenózní trombolýzu v léčbě akutního mozkového infarktu - verze 2014. Cesk Slov Neurol N 2014; 77/110(3): 381-385.
  29. Okuda Y, Sagami F, Tirone P, Morisetti A, Bussi S, Masters RE. Reproductive and developmental toxicity study of gadobenate dimeglumine formulation (E7155) (3)--Study of embryo-fetal toxicity in rabbits by intravenous administration [Japanese]. J Toxicol Sci 1999; 24(Suppl. 1): 79-87. Go to original source... Go to PubMed...
  30. Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP 3rd, Gentile F, Jneid H, Krieger EV, Mack M, McLeod C, O'Gara PT, Rigolin VH, Sundt TM 3rd, Thompson A, Toly C. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2021; 143(5): e35-e71. Go to original source... Go to PubMed...
  31. Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, Biller J, Brown M, Demaerschalk BM, Hoh B, Jauch EC, Kidwell CS, Leslie-Mazwi TM, Ovbiagele B, Scott PA, Sheth KN, Southerland AM, Summers DV, Tirschwell DL. Guidelines for the Early Management of Patients with Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals from the American Heart Association/American Stroke Association. Stroke. 2019; 50(12): e344-e418. Go to original source... Go to PubMed...
  32. Sharshar T, Lamy C, Mas JL. Incidence and causes of strokes associated with pregnancy and puerperium. A study in public hospitals of Ile de France. Stroke in Pregnancy Study Group. Stroke. 1995; 26(6): 930-6. Go to original source... Go to PubMed...
  33. Schrale RG, Ormerod J, Ormerod OJ. Percutaneous device closure of the patent foramen ovale during pregnancy. Catheter Cardiovasc Interv 2007; 69(4): 579-83. Go to original source... Go to PubMed...
  34. Sibai B, Dekker G, Kupferminc M. Pre-eclampsia. Lancet 2005; 365(9461): 785-99. Go to original source... Go to PubMed...
  35. Sousa Gomes M, Guimarães M, Montenegro N. Thrombolysis in pregnancy: a literature review. J Matern Fetal Neonatal Med. 2019; 32(14): 2418-2428. Go to original source... Go to PubMed...
  36. Swartz RH, Cayley ML, Foley N, Ladhani NNN, Leffert L, Bushnell C, McClure JA, Lindsay MP. The incidence of pregnancy-related stroke: a systematic review and metaanalysis. Int J Stroke 2017; 12: 687-697. Go to original source... Go to PubMed...
  37. Šaňák D, Neumann J, Tomek A, Školoudík D, Škoda O, Mikulík R, Herzig R, Václavík D, Bar M, Roček M, Krajina A, Köcher M, Charvát F, Pádr R, Cihlář F. Doporučení pro rekanalizační léčbu akutního mozkového infarktu - verze 2016. Cesk Slov Neurol N 2016; 79/112(2): 231-234.
  38. van Alebeek ME, de Heus R, Tuladhar AM, de Leeuw FE. Pregnancy and ischemic stroke: a practical guide to management. Curr Opin Neurol 2018; 31(1): 44-51. Go to original source... Go to PubMed...
  39. Williams TL, Lukovits TG, Harris BT, Harker Rhodes C. A fatal case of postpartum cerebral angiopathy with literature review. Archives of Gynecology and Obstetrics 2007; 275(1): 67-77. Go to original source... Go to PubMed...




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