Stroke in Pregnancy and Perinatal Period

Abstract

Introduction Stroke is a rare illness in pregnancy; nevertheless, it is one of the main causes of morbidity in young women of childbearing age. During pregnancy, a woman's body undergoes a number of pathophysiological changes that promote thrombus formation and increase the risk of stroke in comparison to women of the same age who are not pregnant. At that time, estrogens increase renin activity leading to increased sodium and water retention; heart rate goes up by 30-50%; cardiac output and arrhythmia index increase, venous capacity raises; venous return decreases; the vessel walls undergo remodeling; and the amount of elastin and collagen fibers decrease. The coagulation system presents a natural predominance of coagulation processes over fibrinolysis [1,2]. Factors increasing the risk of stroke include: the age of the pregnant woman (over 35), hypertension, obesity, smoking, systemic lupus, migraine with aura, diabetes, thrombophilia, pre-eclampsia and eclampsia, prolonged delivery, pregnancy intoxication, infection after delivery [2]. A meta analysis of Swartz et al. [3] covering the period from 1990 to 2017 showed that the prevalence of all strokes in pregnancy was 30.00 per 100,000 pregnant women (with a 95% confidence interval; 18.8-47); for ischemic strokes 19.9 (10.736.9); for hemorrhagic strokes 12.20 (6.7-2.2); and for strokes after delivery 14.7 (8.3-26.1). Ischemic and haemorrhagic strokes are most commonly observed in the last trimester of pregnancy and in the postpartum period [4].