Haemorrhagic stroke in pregnancy

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Authors: N. Svobodová ¹; P. Kaščák ^1,2 ; M. Bojda ³
Authors place of work: Gynekologicko-pôrodnícka klinika, FN Trenčín, Slovenská republika ¹; Fakulta zdravotníctva, TnUAD, Trenčín, Slovenská republika ²; Neurologické oddelenie, FN Trenčín, Slovenská republika ³
Published in the journal: Ceska Gynekol 2024; 89(2): 108-112
Category: Kazuistika
doi: https://doi.org/10.48095/cccg2024108

Summary

Objective: To present a case of acute haemorrhagic stroke during 3rd trimester of pregnancy and to describe management and successful delivery of healthy baby. Case report: Haemorrhagic stroke is responsible for significant morbidity and mortality. Prognosis can be improved only by urgent diagnosis and care. We report a case of pregnant woman at 37^th week of pregnancy with acute haemorrhagic stroke of unknown etiology with clinical appearance of thunderclap headaches and overall disorientation. We describe diagnostic approach and a successful management followed by further differential diagnosis and treatment. The foetus was delivered by acute caesarean section at 37^th week of pregnancy. Conclusion: Occurrence of haemorrhagic stroke in pregnancy is rare. There are no specific guidelines that recommend the time and mode of delivery; therefore, each case is assessed individually.

Keywords:

pregnancy – haemorrhagic stroke – stroke management

Zdroje

1. Elgendy IY, Gad MM, Mahmoud AN et al. Acute stroke during pregnancy and puerperium. J Am Coll Cardiol 2020; 75 (2): 180–190. doi: 10.1016/j.jacc.2019.10.056.

2. Unnithan AK, Das JM, Mehta P. Hemorrhagic stroke. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing 2022.

3. Liew J, Feghali J, Huang J. Intracerebral and subarachnoid hemorrhage in pregnancy. Handb Clin Neurol 2020; 172: 33–50. doi: 10.1016/B978-0-444-64240-0.00002-7.

4. Cauldwell M, Rudd A, Nelson-Piercy C. Management of stroke and pregnancy. Eur Stroke J 2018; 3 (3): 227–236. doi: 10.1177/2396987318769547.

5. Zambrano MD, Miller EC. Maternal stroke: an update. Curr Atheroscler Rep 2019; 21 (9): 33. doi: 10.1007/s11883-019-0798-2.

6. Wang A, Saad AF. Hemorrhagic stroke in pregnancy. Clin Obstet Gynecol 2022; 66 (1): 223–230. doi: 10.1097/GRF.0000000000000739.

7. Swartz RH, Cayley ML, Foley N et al. The incidence of pregnancy-related stroke: a systematic review and meta-analysis. Int J Stroke 2017; 12 (7): 687–697. doi: 10.1177/1747493017723271.

8. Meeks JR, Bambhroliya AB, Alex KM et al. Association of primary intracerebral hemorrhage with pregnancy and the postpartum period. JAMA Netw Open 2020; 3 (4): e202769. doi: 10.1001/jamanetworkopen.2020.2769.

9. Ascanio LC, Maragkos GA, Young BC et al. Spontaneous intracranial hemorrhage in pregnancy: a systematic review of the literature. Neurocrit Care 2019; 30 (1): 5–15. doi: 10.1007/s12028-018-0501-4.

10. Miller EC, Leffert L. Stroke in pregnancy: a focused update. Anesth Analg 2020; 130 (4): 1085–1096. doi: 10.1213/ANE.00000000000 04203.

11. Ladhani NN, Swartz RH, Foley N et al. Canadian stroke best practice consensus statement: acute stroke management during pregnancy. Int J Stroke 2018; 13 (7): 743–758. doi: 10.1177/1747493018786617.

12. Skidmore FM, Williams LS, Fradkin KD et al. Presentation, etiology, and outcome of stroke in pregnancy and puerperium. J Stroke Cerebrovasc Dis 2001; 10 (1): 1–10. doi: 10.1053/jscd.2001.20977.

13. Camargo EC, Feske SK, Singhal AB. Stroke in pregnancy: an update. Neurol Clin 2019; 37 (1): 131–148. doi: 10.1016/j.ncl.2018.09.010.

14. Fairhall JM, Stoodley MA. Intracranial haemorrhage in pregnancy. Obstet Med 2009; 2 (4): 142–148. doi: 10.1258/om.2009.090030.

15. Goldstein JN, Fazen LE, Snider R et al. Contrast extravasation on CT angiography predicts hematoma expansion in intracerebral hemorrhage. Neurology 2007; 68 (12): 889–894. doi: 10.1212/01.wnl.0000257087.22852.21.

16. Hemphill JC 3rd, Greenberg SM, Anderson CS et al. Guidelines for the management of spontaneous intracerebral hemorrhage: a guideline for healthcare professionals from the American heart association/American stroke association. Stroke 2015; 46 (7): 2032–2060. doi: 10.1161/STR.0000000000000069.

17. Tirada N, Dreizin D, Khati NJ et al. Imaging pregnant and lactating patients. Radiographics 2015; 35 (6): 1751–1765. doi: 10.1148/rg.2015 150031.

18. Pacheco LD, Hankins GD, Saad AF et al. Acute management of ischemic stroke during pregnancy. Obstet Gynecol 2019; 133 (5): 933–939. doi: 10.1097/AOG.0000000000003220.

19. McGurgan IJ, Ziai WC, Werring DJ et al. Acute intracerebral haemorrhage: diagnosis and management. Pract Neurol 2020; 21 (2): 128–136. doi: 10.1136/practneurol-2020-002763.

20. Khalifeh A, Berghella A, Moreno S et al. Stroke recurrence in pregnancy: experience at a regional referral center. Eur J Obstet Gynecol Reprod Biol 2019; 236: 75–78. doi: 10.1016/j.ejogrb.2019.03.005.

21. ElFarra J, Martin JN Jr. Pregnancy-related stroke. Crit Care Obstetr 2018; 6: 671–698. doi: 10.1002/9781119129400.ch42.

22. Vaňková B, Březina J, Pánková S. Subarachnoidálni krvácení u matky v graviditě. Ceska Gynekol 2018; 83 (1): 40–44.

23. Aman SU, Abdulla M, Syed A et al. Preeclampsia with hemorrhagic stroke: a case report of a woman’s perilous journey through motherhood with a miraculous ending. J South Asian Feder Obst Gynae 2021; 13 (4): 269–271. doi: 10.5005/jp-journals-10006-1929.

24. Laadioui M, Bouzoubaa W, Jayi S et al. Spontaneous hemorrhagic strokes during pregnancy: case report and review of the literature. Pan Afr Med J 2014; 19: 372. doi: 10.11604/pamj. 2014.19.372.5422.

ORCID autora

P. Kaščák 0000-0002-4142-5561

Doručené/Submitted: 18. 10. 2023
Prijaté/Accepted: 20. 11. 2023

MUDr. Natália Svobodová

Gynekologicko-pôrodnícka klinika

FN Trenčín

Legionárska 594/28

911 01 Trenčín

Slovenská republika

natalia.dudejova@gmail.com