Acute Management of Ischemic Stroke During Pregnancy

Luis Pacheco, Gary Hankins, Antonio F. Saad, George R. Saade

Research output: Contribution to journalArticle

Abstract

Acute stroke in pregnancy can be devastating. Although neurologists will at some point be involved in the management, most of these patients are likely to first be evaluated by an obstetric care provider. It is, therefore, important for obstetric care providers to have an understanding of the presentation and management of stroke, particularly in the initial period when the window of opportunity for therapy is critical. Once suspected, a head computed tomography (CT) without contrast media should be performed without delay to rule out a hemorrhagic component. Patients presenting within 4.5 hours of symptom onset and with an initial normal head CT scan are candidates for alteplase (tissue plasminogen activator [tPA]). Blood pressure (BP) control is paramount when administering tPA. During pregnancy, we recommend maintaining a BP between 140-160/90-110 mm Hg during tPA treatment. Pregnancy should not be a contraindication for mechanical thrombectomy in carefully selected patients. The use of therapeutic anticoagulation during the acute management of ischemic stroke is not indicated owing to an increased risk of hemorrhagic transformation. Supportive therapy should include aggressive treatment of fever, avoidance of hypotonic maintenance fluids, and maintenance of normal serum sodium levels. Serum glucose levels should be kept between 140 and 180 mg/dL. Antiplatelet agents are indicated for secondary prevention. The management of cerebral venous sinus thrombosis, carotid and vertebral dissections, and reversible cerebral vasoconstrictive disease should overall follow same guidelines as for nonpregnant individuals.

Original languageEnglish (US)
Pages (from-to)933-939
Number of pages7
JournalObstetrics and gynecology
Volume133
Issue number5
DOIs
StatePublished - May 1 2019

Fingerprint

Tissue Plasminogen Activator
Stroke
Pregnancy
Obstetrics
Head
Tomography
Maintenance
Blood Pressure
Intracranial Sinus Thrombosis
Thrombectomy
Platelet Aggregation Inhibitors
Therapeutic Uses
Therapeutics
Secondary Prevention
Serum
Venous Thrombosis
Contrast Media
Dissection
Fever
Sodium

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Acute Management of Ischemic Stroke During Pregnancy. / Pacheco, Luis; Hankins, Gary; Saad, Antonio F.; Saade, George R.

In: Obstetrics and gynecology, Vol. 133, No. 5, 01.05.2019, p. 933-939.

Research output: Contribution to journalArticle

Pacheco, Luis ; Hankins, Gary ; Saad, Antonio F. ; Saade, George R. / Acute Management of Ischemic Stroke During Pregnancy. In: Obstetrics and gynecology. 2019 ; Vol. 133, No. 5. pp. 933-939.
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