The clinical characteristics of hemorrhagic stroke during pregnancy: a retrospective study

Abstract

Objective We studied the clinical characteristics of perinatal cerebral haemorrhage, the clinical features of different treatment methods, and patients with different causes, and to investigate the treatment approaches to perinatal cerebral haemorrhage. Methods The clinical data of 76 patients with perinatal cerebral haemorrhage were retrospectively analysed. These patients were treated at Beijing Tiantan Hospital, Capital Medical University between January 1997 and December 2012. They were divided into surgery and conservative treatment groups. Results Patients with perinatal cerebral haemorrhage were relatively young. Of the 76 total patients, 60 were ≤25 years old, including 6 patients who were 19 years old, which suggests that patients with perinatal cerebral haemorrhage were younger than the general cerebral haemorrhage population. The mortality rate was 32% among this young population, . the causes of cerebral haemorrhage included 30 cases of arteriovenous malformation (AVM), 16 cases of preeclampsia, 8 cases of aneurysm (AN), 8 cases of moyamoya disease (MMD), 4 cases of cavernous haemangioma, 4 cases of venous sinus thrombosis, and 6 case of unknown reasons. The average Glasgow coma score (GCS)of patients on admission was 11.8±4.5, GCS 15-11 included 54 cases, GCS 6-10 included 16 cases, GCS 0-5 included 16 cases. The onset of cerebral haemorrhage caused occurred at an earlier gestational age (27.8±9.1 weeks), primarily during mid-pregnancy; this result might be related to an intolerance of cerebrovascular diseases caused by the changes of blood volume and cerebral blood flow that occur during the second trimester, including arteriovenous malformation, aneurysm and cavernous haemangiomas.Of 76 total cases of perinatal cerebral haemorrhage, 24 resulted in maternal death, 4 resulted in intrauterine death, and 28 resulted in neonatal death. The clinical characteristics and maternal and perinatal prognoses of the surgery group did not significantly differ from the conservative group(P>0.05). The mortality rates between the two groups did not differ (P=0.15). Conclusions Pregnancy complicated with hemorrhagic stroke should first terminate the pregnancy and then, neurosurgical treatment should be performed .Patients with a history of cerebrovascular disease should be in intensive care during pregnancy, and terminate pregnancy in a timely manner. General anesthesia is appropriate for cesarean section. At the same time it should prepare well for neonatal rescue. Key words: Pregnancy; Hemorrhagic stroke; Clinical study