Stroke and Pregnancy

Abstract

Background and Purpose —We sought to characterize the subtypes of stroke associated with pregnancy and the puerperium, with emphasis on timing, etiology, risk factors, and outcome. Methods —We conducted a retrospective analysis of patients admitted to the Toronto Hospital between January 1, 1980, and June 30, 1997, with a diagnosis of stroke during pregnancy or within 6 weeks postpartum. Strokes were classified as ischemic (arterial or venous) or hemorrhagic (subarachnoid or intracerebral). All patients were investigated with at least a CT scan of the head, and most had MRI and/or cerebral angiography. Results —Of approximately 50 700 admissions for delivery, 34 patients with a diagnosis of stroke were identified (21 infarctions and 13 hemorrhages). Of patients with infarction, 13 were arterial and 8 were venous. Nine of 13 arterial events occurred in the third trimester or puerperium. Seven of 8 venous occlusions occurred postpartum. An etiologic diagnosis was made in 7 of 13 patients with arterial territory infarction, including cardiac emboli, coagulopathies, and carotid artery dissection. Of patients with hemorrhage, 7 were subarachnoid and 6 were intracerebral. The etiology was identified in 10 patients: 3 were due to ruptured aneurysms, 5 were associated with arteriovenous malformations, and 2 were associated with disseminated intravascular coagulation. All patients with infarction survived, but 3 patients with hemorrhage died. Conclusions —The majority of strokes associated with pregnancy were arterial occlusions. Most presented during the third trimester and puerperium.