O68. Management of eclampsia and stroke during pregnancy

Abstract

Listen

Translate article

Introduction Eclampsia and stroke during pregnancy are major causes of maternal death in the world. Despite the ubiquity of these conditions and their public health impact, neither their etiologies nor therapeutic strategies for their treatment have been established. Objectives To establish the etiologies and therapeutic strategies for eclampsia and stroke during pregnancy, Methods We performed a questionnaire based long-term survey in Aichi prefecture, Japan in 2007, 2010, and 2013. Aichi prefecture accounts for 7% of the Japanese population as well as 7% of annual births in Japan. The questions were designed to obtain detailed information about the cases of eclampsia and stroke during pregnancy experienced by the participating institutions between 2005 and 2012 including the number of cases of each condition; their locations, outcomes, and prognoses; and the treatments employed. Questionnaire recovery rate was 100%. Results This survey revealed the following findings; 66% of deliveries were managed in primary medical facilities, 38% of eclampsia and 39% of stroke occurred at primary medical facilities, and 26% of stroke occurred at home. 37% of eclampsia and 18% of stroke occurred during labor. More than half of them were associated with hypertension firstly detected after the onset of labor (labor onset hypertension). We revealed that 24% of pregnant women who remained normotensive throughout pregnancy developed labor onset hypertension. We also investigated a lot of cases with eclampsia and/or stroke and revealed important issues regarding their management. In case with eclampsia, we should give priority to emergent care and fetal heart rate monitoring. Accurate antihypertensive and anticonvulsive treatment are necessary. While discrimination between eclampsia and stroke is difficult, brain CT and MRI can detected most of hemorrhagic stroke. When stroke is detected, collaborative treatment with neurosurgeon should be started. Detailed blood pressure measurement during labor is also important especially on having thought about the existence of labor onset hypertension. Conclusion These findings might aid the development of therapeutic strategies for pregnant women with eclampsia or stroke.