Maternal mortality related to cerebrovascular disease in Turkey (2012-2019): a national registry-based analysis

To describe national patterns of maternal deaths related to cerebrovascular disease in Turkey and to compare hemorrhagic and ischemic stroke-related deaths, including delay components.

We retrospectively reviewed 140 maternal deaths attributed to cerebrovascular disease recorded in the Turkish Ministry of Health National Maternal Mortality Database (2012-2019). Cases were classified as hemorrhagic or ischemic stroke. We evaluated maternal characteristics, pregnancy timing, clinical/radiologic features, management, and contributing factors. Delays were assessed using the three-delay framework, focusing on patient-related delay (Delay I) and health system-related delay (Delay III).

Cerebrovascular disease accounted for a maternal mortality rate of 1.36 per 100,000 live births and 9.3 % of all maternal deaths. Most deaths were due to hemorrhagic stroke (83.5 %, 117/140), with ischemic stroke comprising 16.4 % (23/140). Stroke onset clustered in the third trimester, whereas deaths occurred predominantly in the postpartum period in both groups. Blood pressure at onset was higher in hemorrhagic than ischemic stroke (median 170/100 vs 130/80 mmHg; p < 0.001 for systolic and diastolic). Magnesium sulfate and acute antihypertensive therapy were used more frequently among hemorrhagic cases (both p < 0.001). Overall, at least one recorded delay (Delay I and/or Delay III) was identified in 38.6 % of cases (54/140), including 40.2 % of hemorrhagic deaths (47/117) and 30.4 % of ischemic deaths (7/23).

In Turkey, fatal maternal cerebrovascular disease most often involves hemorrhagic stroke in the context of severe hypertension and occurs around late pregnancy and the early postpartum period. Improving blood pressure surveillance and response during pregnancy and postpartum, alongside earlier recognition and faster pathways to referral, neuroimaging, and multidisciplinary care, may reduce preventable deaths by addressing both patient- and system-level delays.