Cerebrovascular disorders complicating pregnancy - Beyond eclampsia

A. G. Witlin, S. A. Friedman, R. S. Egerman, A. Y. Frangieh, B. M. Sibai, E. Amon, George Saade, J. C. Morrison

Research output: Contribution to journalArticle

90 Citations (Scopus)

Abstract

OBJECTIVE: Our purpose was to investigate the problems encountered in the diagnosis and management of cerebrovascular disorders associated with pregnancy and the puerperium. STUDY DESIGN: Pregnancies complicated by cerebrovascular disorders were identified by retrospective chart review (1985 to 1995). Events associated with trauma, neoplasm, drug ingestion, and infection were excluded. RESULTS: The study population comprised 24 women with a variety of cerebrovascular disorders: 14 with infarction (5 arterial, 9 venous). 6 with intracranial hemorrhage (3 anatomic malformation, 3 unknown etiology), 3 with hypertensive encephalopathy, and 1 with an unruptured aneurysm. Blood pressure reflected physical condition at presentation and did not predict diagnosis or outcome except in the 3 women with hypertensive encephalopathy. Only 4 of 14 women with infarction and 1 of 6 with intracranial hemorrhage had a diastolic blood pressure ≤110 mm Hg. Presumption of eclampsia delayed the diagnosis in 10 women (41.7%). In addition, patient delay in seeking medical attention complicated 10 cases. After review, none of the adverse maternal outcomes were deemed preventable by earlier physician intervention. Seven maternal deaths occurred (29.2%). Neonatal outcome was related to the gestational age and the maternal condition at presentation. CONCLUSION: Cerebrovascular disorders are an uncommon and unpredictable complication of pregnancy that are associated with substantial maternal and fetal mortality. Suspected eclampsia unresponsive to magnesium sulfate therapy warrants an immediate neuroimaging study. Interestingly, in women with intracranial hemorrhage, severe hypertension was not an associated predictive factor.

Original languageEnglish (US)
Pages (from-to)1139-1148
Number of pages10
JournalAmerican Journal of Obstetrics and Gynecology
Volume176
Issue number6
DOIs
StatePublished - 1997
Externally publishedYes

Fingerprint

Cerebrovascular Disorders
Eclampsia
Intracranial Hemorrhages
Pregnancy
Hypertensive Encephalopathy
Blood Pressure
Infarction
Surrogate Mothers
Fetal Mortality
Magnesium Sulfate
Maternal Death
Pregnancy Complications
Maternal Mortality
Delayed Diagnosis
Neuroimaging
Postpartum Period
Gestational Age
Aneurysm
Eating
Mothers

Keywords

  • Cerebrovascular disorders
  • Eclampsia
  • Pregnancy

ASJC Scopus subject areas

  • Medicine(all)
  • Obstetrics and Gynecology

Cite this

Witlin, A. G., Friedman, S. A., Egerman, R. S., Frangieh, A. Y., Sibai, B. M., Amon, E., ... Morrison, J. C. (1997). Cerebrovascular disorders complicating pregnancy - Beyond eclampsia. American Journal of Obstetrics and Gynecology, 176(6), 1139-1148. https://doi.org/10.1016/S0002-9378(97)70327-2

Cerebrovascular disorders complicating pregnancy - Beyond eclampsia. / Witlin, A. G.; Friedman, S. A.; Egerman, R. S.; Frangieh, A. Y.; Sibai, B. M.; Amon, E.; Saade, George; Morrison, J. C.

In: American Journal of Obstetrics and Gynecology, Vol. 176, No. 6, 1997, p. 1139-1148.

Research output: Contribution to journalArticle

Witlin, AG, Friedman, SA, Egerman, RS, Frangieh, AY, Sibai, BM, Amon, E, Saade, G & Morrison, JC 1997, 'Cerebrovascular disorders complicating pregnancy - Beyond eclampsia', American Journal of Obstetrics and Gynecology, vol. 176, no. 6, pp. 1139-1148. https://doi.org/10.1016/S0002-9378(97)70327-2
Witlin, A. G. ; Friedman, S. A. ; Egerman, R. S. ; Frangieh, A. Y. ; Sibai, B. M. ; Amon, E. ; Saade, George ; Morrison, J. C. / Cerebrovascular disorders complicating pregnancy - Beyond eclampsia. In: American Journal of Obstetrics and Gynecology. 1997 ; Vol. 176, No. 6. pp. 1139-1148.
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