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Pregnancy and ischemic stroke: a practical guide to management.

Mayte E van Alebeek1, Roel de Heus2, Anil M Tuladhar1

  • 1Department of Neurology, Radboud University Medical Center, Donders Institute for Brain Cognition and Behaviour, Nijmegen.

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Ischemic stroke risk increases during pregnancy and postpartum. Management requires multidisciplinary care, with MRI or low-dose CT, and reperfusion therapies considered when beneficial.

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Area of Science:

  • Neurology
  • Obstetrics
  • Maternal-Fetal Medicine

Background:

  • Ischemic stroke in pregnancy/puerperium is a critical condition lacking robust evidence-based guidelines.
  • Current management relies heavily on expert opinion due to limited high-quality studies.

Purpose of the Study:

  • To provide a practical guide for the acute management of ischemic stroke in pregnant and postpartum women.
  • To address the rising incidence of stroke during pregnancy.

Main Methods:

  • Review of current literature and guidelines on stroke management in pregnancy.
  • Synthesis of evidence regarding diagnostic modalities and therapeutic interventions.

Main Results:

  • Stroke risk is significantly elevated from the third trimester through six weeks postpartum.
  • MRI is the preferred diagnostic tool; low-dose CT is an alternative.
  • Reperfusion therapies and low-dose aspirin (up to 150mg) are considered safe and effective when indicated.

Conclusions:

  • Multidisciplinary care is crucial for optimal management of pregnant/postpartum women with ischemic stroke.
  • Timely diagnosis and treatment, including reperfusion therapies, are essential.
  • Aspirin is generally well-tolerated during pregnancy and lactation.