ACUTE CEREBROVASCULAR ACCIDENTS IN PREGNANCY, LABOR AND POSTPARTUM

Background: Acute cerebrovascular accidents are rare and serious complication of pregnancy, labor and puerperium, leading to an increase in maternal and perinatal morbidity and mortality. More than 12% of maternal mortality is related to stroke. Aim: To assess the impact of pregnancy on the incidence of stroke, as well as the impact of cerebrovascular disorders on pregnancy, labor and puerperium. Materials and methods: We retrospectively and prospectively analyzed the course of pregnancy, labor and puerperium in 136 female patients with strokes of various etiologies. The diagnosis of stroke and cerebrovascular disorders was verified with magnetic resonance imaging, angiography, conventional and multiaxial computerized tomography, ophthalmoscopy, electroencephalography, electrocardiography and echocardiography (trans-thoracic and trans-esophageal), 24-hour blood pressure monitoring and electrocardiogram monitoring, ultrasound assessment of extra and intracranial vasculature with duplex scanning, cerebral angiography and laboratory assessments. Results: The analysis of 92 strokes that occurred during pregnancy, labor and postpartum showed that 38% of the cases (n=35) were caused by various cerebrovascular abnormalities. In 18.5% of the cases (n=17), acute cerebrovascular accidents occurred in patients with preeclampsia/eclampsia. Most often (84.8%, or 78/97 of cases) strokes or other cerebrovascular accidents developed in II and III trimesters. The most severe cases were patients with intracranial hemorrhages (n=31). In this group, there were 5  deaths of mothers, 1  antenatal and 1  neonatal fetal deaths. In 90% of these cases (28/31), intracranial hemorrhage in pregnancy was related to manifestation of intracerebral vascular abnormality (arteriovenous malformations, arterial aneurysms, cavernomas). We observed a 4-fold rate of arteriovenous malformation ruptures during pregnancy (21 cases vs. 5). The rates of arterial aneurysm and cavernoma ruptures during pregnancy and in the past history were comparable (6 and 8 cases and 4 and 6 cases, respectively). Conclusion: An acute cerebrovascular accident is a hazardous complication of pregnancy, which increases maternal and perinatal morbidity and mortality. Pregnancy increases the risk of manifestation of brain arteriovenous malformations.