Incidence, predictors, types and outcome of Post-Partum stroke: A population based study

There is growing incidence of postpartum stroke globally. We aim to assess the incidence rate, predicting factors and outcome of postpartum stroke in a middle income country. In one year long bidirectional study, patients with acute postpartum stroke developed within six weeks after delivery were cases compared to matched control group without stroke in 1:2 ratio. Gestational age, number of pregnancies, BMI, comorbid conditions, evidence of infection, history of stroke, headache, proteinuria, and anemia at time of presentation were exposure variables. The outcome measures were incidence of postpartum stroke and functional outcome of postpartum stroke within four weeks of its development.

The incidence rate was 112 new strokes per 100,000 deliveries. The mean ages of cases (290) and controls (400) were 29.5±7.4 and 26.6±5.2 respectively. Among postpartum strokes, 54.8% were ischemic, 22.4% hemorrhagic, 20% venous infarcts, and 2.8% RCVS. Compared with control group patient with postpartum stroke were more likely to be overweight (OR 2.6; 95%CI, 1.71-4.14), anemic (OR, 4.4; CI, 2.50, 8.06), grandmultiparous (OR 2.5 ; CI, 1.27, 5.15), smoker (3.4; CI, 1.76, 6.7), had history of previous stroke (3.77; CI, 1.84, 7.72), migraine (OR 15 ; CI, 8.58, 26.26), infection (OR 2.9; CI, 1.81, 4.94) and heavy proteinuria (OR 4.4; CI, 2.5, 8.06),. Among cases 32 (11%) were died while 70.9% of the survivors had no residual weakness. According to the modified Rankin Score, 79% of post-partum stroke patients had good outcomes, while 61 (21%) had poor outcomes, 32 of whom died within 28 days.

The incidence of postpartum stroke is increasing, particularly in low-income countries. Patients with established risk factors for postpartum stroke should get particular attention and all possible measures should be taken to mitigate those risk factors.