Acute Cerebrovascular Disease in Pregnancy and Puerperium: Description of Cases from a Mexican Multicenter Registry (RENAMEVASC) (P01.035)

Abstract

Objective: To describe CVD cases occurring during pregnancy or puerperium in Mexican hospitals. Background Pregnancy and puerperium are physiological conditions associated with a high risk of acute cerebrovascular disease (CVD). Comparative data on the association of pregnancy and puerperium among the different types of acute CVD is sparse. Design/Methods: We analyzed 2000 patients with different types of acute CVD included in a registry conducted in 25 referral hospitals. Research records of cases occurring during pregnancy or puerperium (the first 40 days after delivering) were selected. Results: We identified 45 (2.3%, 95% confidence interval: 1.7% to 3.0%) women with CVD associated with pregnancy or puerperium (mean age 26.3 years, range: 14-39): 20 (44%) in pregnant women and 25 (56%) during puerperium. A total of 26 (58%) cases corresponded to cerebral vein thrombosis (CVT), 10 (22%) to intracerebral hemorrhage (ICH) and 9 (20%) to acute ischemic stroke (AIS). No association with subarachnoid hemorrhage was identified. As compared with puerperium, pregnancy was more common among AIS (56% vs 44%, respectively) and ICH cases (90% vs 10%, respectively), but the inverse characteristic was observed in CVT cases (23% vs 77%, respectively). Ten (22%) patients presented preeclampsia/eclampsia: 7 (70%) in association with ICH, 2 (22%) with AIS and only one (4%) with CVT. The 30-day case fatality rate was 4%, (2 pregnant women: one with ICH and the other with CVT); however, the frequency of women with a modified Rankin scale >2 was 17%; more common among patients with ICH (60%), than in AIS (14%) and CVT (9%) cases. Conclusions: CVT is the main type of acute CVD occurring during pregnancy or puerperium. Preeclampsia/eclampsia was mainly associated with ICH, whereas CVT may be associated with a prothrombotic, non-hypertensive state. Mortality rate is low, but at expense of a significant proportion of disabled young women. Disclosure: Dr. Chiquete has nothing to disclose. Dr. Flores has nothing to disclose. Dr. Florez has nothing to disclose. Dr. Salas has nothing to disclose. Dr. Reyes-Melo has nothing to disclose. Dr. Villarreal-Careaga has nothing to disclose. Dr. Murillo-Bonilla has nothing to disclose. Dr. Leon-Jimenez has nothing to disclose. Dr. Ruiz-Sandoval has nothing to disclose. Dr. Gonzalez-Duarte has nothing to disclose. Dr. Garcia-Ramos has nothing to disclose. Dr. Cantu-Brito has nothing to disclose.