Eclampsia and stroke during pregnancy are major causes of maternal and neonatal death in many countries. Herein, we describe the etiologies of and therapeutic strategies for eclampsia and stroke during pregnancy.
The incidence of eclampsia is 0.03–0.28% of deliveries, and its prognosis is improved. The incidence of pregnancy-associated stroke is 0.004–0.21%, and its maternal mortality rate ranges from 9 to 38%.
Hypertension is a risk factor for eclampsia and stroke. In pregnant patients whose blood pressure is greater than 180/120 mmHg, the use of MgSO4 and antihypertensive agent is necessary. Clinicians should also pay attention to the presence of hypertension that first occurs during delivery. Repeated blood pressure measurements are necessary for the successful management of hypertension during labor.
In pregnant women with eclampsia or stroke, clinicians should give priority to emergent care and administer appropriate antihypertensive and anticonvulsive treatment. In cases of eclampsia or stroke that occurs before delivery, an emergent delivery should be considered. Discriminating between eclampsia and stroke based on neurological symptoms alone is difficult, and so computed tomography and/or magnetic resonance imaging-based brain scans should be obtained. When a stroke is detected, collaborative treatment with a neurosurgeon should be started as soon as possible. If a stroke is suspected at a primary medical facility or outside a medical facility, rapid maternal transport to an intensive medical facility is necessary. HELLP syndrome can markedly increase the degree of difficulty of neurosurgical operations. Indications for the surgical treatment of pregnancy-associated stroke that take account of the challenges encountered in the obstetrics setting should be developed.
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I warmly thank Dr. Kanji Tanaka (Hirosaki University), Dr. Katsumi Sakakibara (Okazaki Municipal Hospital), Dr. Michiyasu Kawai (Toyohashi Municipal Hospital), Dr. Shigehiko Morikawa (Komaki Municipal Hospital), and Dr. Shinichi Yamamoto (Kariya Toyota Hospital) for their support and case provision.
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