Management of stroke in pregnancy and the puerperium

Pregnancy and the puerperium have been recognized to increase the risk of stroke, particularly from late pregnancy and through the puerperium. The reported incidences of stroke during pregnancy and the puerperium varied widely, ranging from 5 to 67 per 100,000 deliveries or pregnancies. Important causes of stroke during pregnancy and the puerperium include preeclampsia and eclampsia, cardioembolism, rupture of cerebral vascular anomaly, peripartum or postpartum cerebral angiopathy and cerebral venous thrombosis. Management of patients with pregnancy-related stroke is largely the same as that of nonpregnant patients, with more consideration on maternal and fetal risks. Low-dose aspirin reduces the occurrence of perinatal deaths and preeclampsia in women with historical risk factors for preeclampsia. Anticoagulation during pregnancy is indicated for current arterial or venous thromboembolism, prior venous thromboembolism on long-term anticoagulation, antiphospholipid syndrome with prior venous thromboembolism and patients with a mechanical heart valve. Data from thrombolytic therapy for pregnant women with acute ischemic stroke are limited. It is critical that the risks and benefits of thrombolytic therapy for pregnant women and fetuses are considered cautiously.