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Tuesday, Sept. 29, 2015

Stroke Prevention

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Women with preeclampsia at major risk

While not particularly common, the risk of a stroke during pregnancy poses significant dangers.

As defined by the American Heart Association, a stroke is a disease that affects the arteries and is the No. 5 leading cause of death and a leading cause of disability in the United States. It occurs when the brain doesn’t receive the oxygen and nutrients carried by a particular blood vessel due to a blockage by clot or rupture. According to the AHA, strokes occur more often in women and kill more women than men. Furthermore, pregnant women are more at risk for stroke than women who are not.

According to the AHA, a factor that increases stroke risk in pregnant women is preeclampsia. A condition that involved increased blood pressure and protein in urine, preeclampsia can become problematic if left untreated.

Dr. John D. Haynes, who has the credential of a Fellow of The American Congress of Obstetricians and Gynecologists, with Pierremont OBGYN Specialists said other common risk factors include hypertension, diabetes (prepregnancy), obesity, clotting abnormalities (thrombophilias), substance abuse (particularly smoking, methamphetamine and cocaine use) sickle cell disease, artificial heart valve and lupus.

Obesity, in particular, is listed as a risk factor by the AHA due to the fact that the larger a waist circumference, the greater the risk of stroke. Obesity is also often associated with other conditions and risk factors such as diabetes and cholesterol issues. It is noted women should be screened for hypertension, another common risk factor, prior to becoming pregnant.

Haynes said strokes in pregnancy are not particularly common, occurring somewhere between 8-15 per 100,000 pregnancies. The complications, however, that may arise with a stroke during pregnancy can have significant and damaging effects.

“Depending on the severity, [the complications] would be similar to strokes in a non-pregnant person, and could range from temporary or permanent weakness or paralysis in one or more part of the body – usually one-sided, temporary or permanent blindness, loss of the ability to speak or understand simple words or phrases, confusion or potentially coma or even death in the most severe cases,” Haynes said. “There may also be fetal considerations, especially in the most severe cases where the life of the mother is in peril, the fetus may also be in severe danger and the situation could possibly necessitate delivery regardless of gestational age.”

While there is often no warning to an oncoming stroke, symptoms are typical of those in non-pregnant persons. Haynes said the most notable feature to the symptoms is their sudden onset.

“Tingling, weakness of the face, arms, legs or numbness, especially one-sided; visual changes, trouble speaking or understanding simple phrases, confusion, sudden loss of balance, headache much worse than usual headache, as well as sudden new seizures [are common symptoms],” he said. “The key is the sudden onset.”

Diagnosing and testing for a stroke can involve a multifaceted approach, collecting information that includes an understanding of a patient’s medical history.

“In addition to careful history and physical exam, MRI and CT imaging of the brain are the mainstays of diagnosis,” Haynes said.

Additionally, according to the AHA, a physical and neurological examination might also be needed in determining a diagnosis.

Treatment for strokes during pregnancy is not without some challenges.

“For thrombotic strokes [clot-related] there is the potential for using thrombolytic drugs, [also known as clot busters] such as recombinant [tissue plasminogen activator] – though use is controversial and there is not experience using these drugs in pregnancy because the incidence is so rare,” Haynes said. “Blood thinners such as heparin may also be used, as well as aspirin, in the very early phases. For hemorrhagic strokes [brain hemorrhage], care is mostly supportive and related to treatment of the effect that bleeding has on the brain, such as drugs to control the swelling, drugs to treat hypertension – if that is a factor, and drugs to treat seizures if present. Surgery may also play a role in the case of hemorrhagic stroke related to aneurysm or other identifiable anatomic causes of bleeding.”

According to the AHA, most strokes are preventable, and that half of all strokes are caused by uncontrolled high blood pressure and hypertension. Understanding the most important risk factors, such as smoking, high blood pressure and physical inactivity and obesity, is key in taking a proactive approach to preventing a stroke.

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For more information on strokes in pregnancy, go to www.strokeassociation.org.

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