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Stroke In Pregnancy

Stroke in Pregnancy:  A Consensus Statement by the Canadian Stroke Best Practices Stroke in Pregnancy Writing Group.

Part One: Prevention of Recurrent Stroke in Pregnant Women and Women Planning a Pregnancy.

Stroke, the sudden loss of neurological function due to neuronal injury of a vascular cause, is a leading cause of disability in adults and when stroke occurs as a complication of pregnancy, the impact on the mother, child and families can be devastating. A recent systematic review and meta-analysis showed that stroke affects 30/100,000 pregnancies [Swartz, Cayley, Foley et al, 2017], roughly 3 times that seen in the general population of young adults [Singhal et al, Neurology, 2013].  Several aspects of pregnancy can increase the risk of stroke including: hypertensive disorders of pregnancy [Leffert et al., Obstetrics and Gynecology, 2015] (chronic hypertension, gestational hypertension, pre-eclampsia, eclampsia) and their complications; HELLP syndrome (hemolysis, elevated liver enzymes and low platelets syndrome) ; hematologic and prothrombotic changes in the third trimester and post-partum periods; hyperemesis resulting in hemoconcentration; and changes to cerebral vasculature (for example, reversible cerebral vasoconstriction syndrome (RCVS), arteriovenous malformations). Given this etiological variability, the practical limitations to clinical trials research in pregnant patients with stroke, and the rarity of events, it is not surprising that there is limited literature to guide important management decisions. Yet, stroke is sufficiently common that most specialists providing either obstetrical or stroke care encounter women with a past stroke wanting to get pregnant, or women who develop a stroke during or after a pregnancy. Thus, there is a need for a rational approach to management decisions, based on the best available literature and guided by expert consensus.

Goal: to provide guidance on the management of stroke in pregnancy based on a critical appraisal of current research evidence on obstetrical and stroke management and expert review and appraisal.

Scope: This document represents a consensus statement based on the process above, focused on the unique aspects of pregnancy-related stroke.  Many consensus statements are applicable to both ischemic and hemorrhagic stroke.  In cases where the statements are applicable to one type or the other, it will be explicitly noted.

Prevention and Pregnancy  Consensus Statement 2017 module contents:

Canadian Stroke Best Practice Consensus Statement: Secondary Stroke Prevention during Pregnancy publication in the International Journal of Stroke

Citing the Secondary Prevention of Stroke during Pregnancy 2017 Module

Richard H Swartz (Co-First Author), Noor Niyar N. Ladhani (Co-First Author),  Norine Foley, Kara Nerenberg, Simerpreet Bal, Jon Barrett, Cheryl Bushnell, Wee-Shian Chan,  Radha Chari, Dariush Dowlatshahi, Meryem El Amrani, Shital Gandhi, Gord Gubitz, Michael D Hill, Andra James, Thomas Jeerakathil, Albert Jin, Adam Kirton, Sylvain Lanthier,  Andrea Lausman, Lisa Rae Leffert  Jennifer  Mandzia,  Bijoy Menon, Aleksandra Pikula, Alexandre Poppe, Jayson Potts, Joel Ray, Gustavo Saposnik, Mukul Sharma, Eric E Smith, Sanjit Bhogal, Elisabeth Smitko, and M Patrice Lindsay (Senior and Corresponding Author),  on behalf of the Heart and Stroke Foundation Canadian Stroke Best Practice Advisory Committees. In Lindsay MP, Gubitz G, Dowlatshahi D, Harrison E, and Smith EE (Editors).  Canadian Stroke Best Practice Recommendations 6th Edition: Secondary Stroke prevention during Pregnancy Consensus Statement, 2017; Ottawa, Ontario Canada: Heart and Stroke Foundation. www.strokebestpractices.ca

Comments

We invite comments, suggestions, and inquiries on the development and application of the Canadian Stroke Best Practice Recommendations.  Please forward comments to the Heart and Stroke Foundation’s Stroke Team at strokebestpractices@heartandstroke.ca.