Management of stroke in pregnancy

Evidence-based neurology checklist on management of stroke in pregnancy: Head imaging Both CT and MRI are safe in pregnancy Angiography may be used if indicated Gadolinium is contraindicated Iodine-based contrast agents are contraindicated: these impair neonatal thyroid function Acute stroke…

Head imaging

  • Both CT and MRI are safe in pregnancy
  • Angiography may be used if indicated
  • Gadolinium is contraindicated
  • Iodine-based contrast agents are contraindicated: these impair neonatal thyroid function

Acute stroke treatment

Secondary stroke prophylaxis

Antihypertensive treatment

Obstetric management

Post-partum management

Treatment of specific stroke types in pregnancy

Acronyms

References

  1. Sidorov EV, Feng W, Caplan LR. Stroke in pregnant and postpartum women. Expert Rev Cardiovasc Ther 2011; 9:1235-1247. 
  2. Hacein-Bey L, Varelas PN, Ulmer JL, Mark LP, Raghavan K, Provenzale JM. Imaging of cerebrovascular disease in pregnancy and the puerperium. Am J Roentgenol 2016; 206:26-38.
  3. Landais A, Chaumont H, Dellis R. Thrombolytic therapy of acute ischemic stroke during early pregnancy. J Stroke Cerebrovasc Dis 2018; 27:e20-e23.
  4. Ryman KM, Pace WD, Smith S, Fontaine GV. Alteplase therapy for acute ischemic stroke in pregnancy: two case reports and a systematic review of the literature. Pharmacotherapy 2019; 39:767-774. 
  5. Szuchy Kristiansen E, Holm Vestergaard H, Modrau B, Oppel LM. Acute ischemic stroke in late pregnancy treated with intravenous thrombolysis and endovascular therapy. Case Rep Neurol 2019; 11:41-46.
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