Stroke in Pregnant Women

May 19 06:28 2023 by admin Print This Article

Women are at a higher risk of stroke compared to men, especially during the child bearing age. Maternal and child care are very important to prevent stroke in women.

Conditions That Affect Women More Than Men and Result in Possible Stroke

• Atrial fibrillation is a condition in which the heart beats rapidly and irregularly; the upper chamber of the heart beats very fast. Little clots from there can be sent like a shower and can result in a cardio embolic stroke. This stroke is more common in women than men.
• Hypertension and atrial fibrillation, key risk factors for stroke, are more in women than men.
• The effect of some risk factors for stroke – including atrial fibrillation and diabetes mellitus– are stronger in women than men.
• Women while pregnant can develop a condition known as eclampsia or pre-eclampsia. This can cause stroke during pregnancy, bleeding in the brain when the BP shoots up and result in intra-cerebral hemorrhage. This intra-cerebral hemorrhage can result in maternal death. Therefore, pregnant women should be monitored carefully.
• Women who don’t have access to education do not know about the aforementioned risk factors and do not get regular check-ups. Women should be encouraged to not miss their routine pregnancy check-ups.
• Regular check-ups during pregnancy will go a long way towards avoiding stroke in women. Routine measurement of blood pressure and routine measurement of albumin in urine can prevent complications in pregnancy.

Factors That Predispose Women Towards Stroke

• Cardiomyopathy – having a heart that is big in size
• Patent foramen ovale – hole in the heart
• Diabetes mellitus – having high sugar levels
• Hypertension – high BP
• Hypertensive disorders of pregnancy
• Tendency for pro-thrombotic states – disturbances in the clotting mechnism
• Cerbral Venous Sinus thrombosis

Focusing on Hypertensive Disorders of Pregnancy

There are maternal, paternal and placental risk factors that can trigger hypertensive disorders of pregnancy.

• Maternal Risk Factors
• Genetic factors
• Young age (<18 years of age)
• Old age (>35 years of age)
• Multiparity
• Obesity
• High cholesterol or triglycerides level
• Physical inactivity
• Alcohol intake
• Paternal Risk Factors
• First pregnancy between father and mother
• The man previously fathered a pregnancy with pre-eclampsia
• Placental Triggers
• Placenta having less blood circulation, less oxygen (hypoxia) and invasion by abnormal cells (trophoblast invasion)

Focusing on Venous Thrombosis

• There is a complete venous system in the brain which can get blocked and cause a cerebral venous thrombosis. This condition can paralyze patients and can be fatal to women during their perinatal period (when the woman delivers and just after delivery).
• It can be caused by dehydration due to diarrhea or insufficient water intake. However, pregnancy by itself predisposes a patient towards cortical venous thrombosis.
• It can be diagnosed with an MRI.
• The newest cause for cerebral venous thrombosis is COVID-19 as has been found recently.

Role of Oral Contraceptives

Oral contraceptives increase ischemic stroke risk. So, they are not given to all women. They cause stroke by increasing blood pressure.

Absolute contraindications for oral contraceptives (WHO Category IV) are given below:

• Migraine with focal neurological symptoms
• During pregnancy and breastfeeding
• Severe hypertension
• Complicated valvular heart disease
• Diabetes with vascular complications
• Active liver disease
• After major surgeries
• Prolonged immobilization

Stroke Risk During Pregnancy Is Higher in Younger Women

It is important to identify risk factors of stroke during pregnancy and give prompt treatment.

• Pregnancy is known to increase risk of stroke
• Stroke during pregnancy is more in women under 35 years of age
• Above 35 years, the risk is the same as non-pregnant women

For women who maintain a healthy weight during pregnancy and have no hypertension and diabetes, the chances of a healthy pregnancy are very high.

First Action in Stroke

Place the emergency call immediately.

You can also do the following while awaiting professional help:

• Check vital signs – breathing, pulse and consciousness
• Keep patient propped up as she may choke on saliva
• If the patient is unconscious, lay her flat and turn him to the side
• Make sure to loosen any tight clothing
• Make sure there is no crowding
• Reassure patient to stop him for panicking

Prevent Stroke

While we are aware that a healthy lifestyle with BP and sugar levels under control will lessen stroke risk considerably, the following two points need special mention for stroke prevention:

• Reducing salt intake is crucial. Added salt is a real danger and can aggravate hypertension.
• With hypertension and diabetes, it is crucial to have a doctor consult at least once in 6 months or anytime a symptom is experienced.

Stroke can be prevented if we work towards it. Stroke can be treated if we seek help at a hospital with a Stroke Center and a Fast Response Policy.

Reviewed by Dr Suresh S Venkita, Group Medical Director, Kauvery Hospitals

Kauvery Hospital is globally known for its multidisciplinary services at all its Centers of Excellence, and for its comprehensive, Avant-Grade technology, especially in diagnostics and remedial care in heart diseases, transplantation, vascular and neurosciences medicine. Located in the heart of Trichy (Tennur, Royal Road and Alexandria Road (Cantonment), Chennai, Hosur, Salem, Tirunelveli and Bengaluru, the hospital also renders adult and pediatric trauma care.

Chennai – 044 4000 6000 • Trichy – Cantonment – 0431 4077777 • Trichy – Heartcity – 0431 4003500 • Trichy – Tennur – 0431 4022555 • Hosur – 04344 272727 • Salem – 0427 2677777 • Tirunelveli – 0462 4006000 • Bengaluru – 080 6801 6801