Neurological Disorders In Pregnancy Research Articles

Neurological disorders in pregnant women in low- and middle-income countries-Management gaps, impacts, and future prospects: A review perspective.

Neurological disorders during pregnancy are a substantial threat to women's health, particularly in low- and middle-income countries. Furthermore, a critical shortage of mental health workers and neurologists exacerbates the already pressing issue, where a lack of coordination of respective healthcare among multidisciplinary teams involved in managing these conditions perpetuates the current state of affairs. Financial restrictions and societal stigmas associated with neurological disorders in pregnancy amplify the situation. Addressing these difficulties would necessitate a multifaceted approach comprising investments in healthcare infrastructure, healthcare professional education and training, increased government support for research, and the implementation of innovative care models. Improving access to specialized treatment and coordinated management of antenatal neurological diseases will precipitate improved health outcomes for women and their families in low- and middle-income countries.

Spectrum of Neurological Complications of Pregnancy on Magnetic Resonance Imaging

Introduction: Catastrophic neurological decline, although exceedingly rare, takes a huge toll on pregnant population. In view of varied symptomatology and risks to the fetus, diagnosis and management of the neurological disorders in pregnancy is always a challenging task. The evaluation and management should be performed in a stepwise fashion and requires a multidisciplinary approach. Radiological imaging, especially magnetic resonance imaging (MRI), has revolutionized the diagnosis of these disorders, thereby exacerbating maternal and fetal outcome. Aim: The present study was conducted with the aim to characterize some of the significant neurological disorders complicating pregnancy and puerperium and to study the role of imaging, especially MRI, in differentiation and exclusion of various neurologic conditions, which helps an obstetrician to point to a specific diagnosis and management. Materials and Methods: Our study was an observational study conducted in the Department of Obstetrics and Gynecology in collaboration with the Department of Radiodiagnosis of GMC, Srinagar, from June 2018 to January 2020. The images were obtained with MRI and subjected for radiological interpretation. Results: A total of 750 patients were included in the study out of which 25 patients had neurological complications. Out of 25 patients, 13 were in the antenatal period and 12 were in the puerperium. There were 10 (40.0%) cases of posterior reversible encephalopathy syndrome (PRES), 6 (24%) cases of cerebral venous thrombosis (CVT), 3 (12.0%) cases of embolic infarcts, 2 (8.0%) cases of status epilepticus, 2 (8.0%) cases of pituitary apoplexy, 1 (4.0%) case of Wernicke encephalopathy, and 1 (4.0%) case of metastasis to brain (choriocarcinoma). Conclusion: Diagnosis of neurological complications of pregnancy and postpartum plays a crucial role in reducing fetomaternal morbidity and mortality. MRI stands above all imaging modalities in early diagnosis of these neurological complications, simultaneously taking care of fetal safety as well. The most common neurological complications that cause increased maternal mortality are PRES and CVT. Hence, early imaging can help in early and appropriate management of serious pregnancy-related neurological catastrophes.

Neurological Disorders in Pregnancy and Puerperium

Neurological Disorders in Pregnancy and Puerperium

Neurological Disorders Complicating Pregnancy - Focus on Obstetric Outcome.

Neurological disorders in pregnancy can be pregnancy related or can be caused by exacerbation of a pre-existing neurological condition or sometimes may even be detected for the first time during pregnancy in which it might be an incidental finding. The diagnosis and management of the neurological disorders in pregnancy is always a challenging task due to varied symptomatology and risks to the fetus. The evaluation and management should be performed in a stepwise fashion and requires multidisciplinary approach. The present study was conducted with the aim to study the influence of neurological disorders on outcome of pregnancy. This was a prospective observational study conduted over a period of 1 year (2013-2014) including 54 pregnant women with neurological manifestations. The spectrum of neurological manifestations was divided into-pregnancy specific, incidental and pre-existing neurological disorders for analysis. Five unusual cases with varied manifestations were studied in detail. Any pregnant woman presenting with neurological manifestation, irrespective of gestational age were included in the present study. The neurological manifestation and the obstetric outcome were analysed in the present study. There were 54 women with varied neurological manifestations, majority (74%) of them being primigravida. Seizure was the most common (63%) manifestation. The incidence of pregnancy specific disorder (eclampsia), pre-existing disease (epilepsy) and incidental causes were 40.8%, 37% and 22.2% respectively. Of the 22 women with eclampsia, 15(68%) had seizure during antepartum period and 7(32%) in the postpartum period. Three patients out of 22 who had eclampsia had intrauterine fetal demise on arrival itself, whereas the perinatal outcome was good in the other 19 patients who had live born babies. The most common incidental cause in the present study was tubercular meningitis (44%). There was however a maternal and perinatal mortality in woman with structural malformation who had massive intra-ventricular haemorrhage, secondary to ruptured cerebral cavernoma. Here we have described in detail 5 patients with varied clinical manifestation causing diagnostic dilemma. They are spinal arterio-venous malformation, disseminated toxoplasmosis, massive intra-ventricular haemorrhage (ruptured cerebral cavernoma), tubercular meningitis with cortical venous thrombosis, suspected Bartter syndrome presenting as coma. Neurological manifestation during pregnancy may not always be a primary neurological disorder, instead may be manifestation secondary to any systemic illness. Hence, a wide index of suspicion and neuroimaging aids in arriving at the diagnosis certainly improves the pregnancy outcome.

Neurological Disorders Associated with Pregnancy: A Hospital Based Imaging Study of 57 Cases in North-East India

Aims: To evaluate and characterize the Computed Tomography and Magnetic Resonance Imaging findings of the various neurological conditions of the central nervous system and pituitary gland that can occur during pregnancy and post partum period. Place and Duration of Study: The study was carried out in the Department of Radiology, Gauhati Medical College and Hospital, Guwahati, from August 2012 to July 2013. Methodology: A total of 57 patients of neurological disorders of the central nervous system and pituitary gland associated with pregnancy, who were referred to the Department for radiological evaluation and who had positive imaging findings were taken up for the study. CT scan was performed in those cases referred for imaging. For further evaluation, cases were referred to MRI Original Research Article Bhuyan et al.; BJMMR, 8(1): 41-51, 2015; Article no.BJMMR.2015.425 42 or wherever possible, cases were directly referred for MRI. Contrast CT was avoided in most of the cases. Results: Out of 57 patients, 54.39% patients were in age between 20 to 30 years. Headache was the most common presenting complaint (71.93%) in all the neurological disorders. Hypertensive encephalopathy (40.35%) was the most common neurological disorder followed by Cerebral Venous Thrombosis (17.54%). Infarct was the commoner complication of hypertensive encephalopathy accounting for 21.74% of cases. Magnetic resonance was able to detect infarct in 21.74% of cases compared to CT which could detect infarct in 13.04% of cases. P value 0.3534 and sensitivity 72%, 95% Confidence Interval 0.46 to 0.90 with negative predictive value 50% with 95% Confidence Interval 0.18 to 0.81. Conclusion: Both CT and MRI can depict the characteristic imaging features of these neurological disorders in pregnancy as well as development of complications, hence leading to early and prompt diagnosis of these disorders and better management of these patients.

Neurological disorders in pregnancy and puerperium

Objectives: To study the clinical profile of the patients presenting with neurological disorders during pregnancy and puerperium. Methods: The study was carried out at Government General Hospital, Kakinada, Andhra Pradesh, India between June 2006 and May 2007. Patients in pregnancy, postabortal and postpartum period evaluated in Neurology out-patient and in-patient departments and referred to Neurology department, Government General Hospital, Kakinada during this time were included in this study. Results: A total of 55 patients presented during pregnancy and puerperium with neurological disorders. Age of the patients ranged from 17 to 31 years. The total number of deliveries in this hospital during this period was 9726. Out of 55 patients Epilepsy—27[49.09%], Eclampsia—11[20%], Cerebro vascular disorders—6[10.9%], Neuropathies —4[7.27%], Extrapyramidal disorders---2[3.64%], CNS infections—Tubercular meningitis –1[1.81%], Myelopathy—1[1.81%], Toxic/ metabolic encephalopathy—1[1.81%]. Conclusions: Epilepsy was the most common neurological condition followed by Eclampsia and Cerebrovascular diseases. Health education measures for prospective mothers regarding the appropriate, adequate and regular use of anti-epileptic drugs should be taken up. Diligent care is to be taken to watch for neurological deficit in cases of Pre-eclampsia/ Eclampsia to identify special investigation team—Obstetrician, Neurologist, Physicians and Neurologist. The treating team should have the complete knowledge of the effects of rare neurological disorders during pregnancy and puerperium. DOI: http://dx.doi.org/10.4038/sljog.v36i3.7722 Sri Lanka Journal of Obstetrics and Gynaecology 2014; 36: 74-78

Clinical characteristics and outcomes of critically ill obstetric patients: a ten-year review

BACKGROUND AND OBJECTIVES:Pregnancy and delivery can involve complications that necessitate admission to critical care facilities. The objective of our study was to assess the incidence, indications, and outcomes of obstetric patients requiring admission to an intensive care unit (ICU) in a tertiary care hospital, in Saudi Arabia.DESIGN AND SETTING:Retrospective cohort study of consecutive obstetric admissions to the ICU at the King Abdulaziz Medical City over a 10-year period.PATIENTS AND METHODS:We collected baseline demographic data and acute physiology and chronic health evaluation II (APACHE II) scores. ICU mortality was the primary outcome.RESULTS:Over 10 years, 75 obstetric patients were admitted to the ICU, and 59 of these patients (78.6%) were admitted during the antepartum period. The main obstetric indication for ICU admission was pregnancy-induced hypertension (21 patients, 28%) and the leading non-obstetric indication was sepsis (12 patients, 16%). The APACHE II score was 19.59 (15.05). The predicted mortality rate based on the APACHE II score was 21.97%; however, there were only six maternal deaths (8%) among the obstetric patients admitted to the ICU.CONCLUSION:The overall mortality was low. A team approach facilitated the application of optimal care to these patients. Obstetric patients had better outcomes than those predicted by the APACHE II scores. Appropriate antenatal care is important for preventing obstetric complications.

Neurological Disorders in Pregnancy

This paper reviews the current concepts and outlines appropriate management of conditions such as epilepsy, headache, benign intracranial hypertension, myasthenia gravis, multiple sclerosis, Bell's palsy and cerebrovascular disorders. It also discusses briefly, labor analgesia and anaesthesia in women with neurological disorders. Keywords: Neurological, pregnancy, epilepsy, myasthenia gravis, multiple sclerosis, benign intracranial hypertension, Bell's palsy, cerebrovascular, headache, AEDs, pulsation (IABP), Pre-eclampsia

Neurological Disorders in Pregnancy from a Neuroimaging Perspective

Pregnancy can precipitate new neurological diseases as a result of the alterations in physiology that accompany the pregnant state. The pregnant patient presenting with neurological problems poses both diagnostic and therapeutic challenges, often forcing the clinician to rely on neuroimaging as part of the workup. This review discusses potential risks to the embryo and fetus posed by computed tomography (CT) and magnetic resonance imaging (MRI), the imaging studies most often used to study the central nervous system. Imaging features of a variety of neurological conditions associated with pregnancy are discussed, including pre-eclampsia and eclampsia, Wernicke's encephalopathy, cerebral venous thrombosis, ischemic stroke, postpartum angiopathy, and lymphocytic hypophysitis.

Jacqueline M. Washington, editor: Neurologic Disorders in Pregnancy

Jacqueline M. Washington, editor: Neurologic Disorders in Pregnancy

Neurologic disorders in pregnancy

Neurologic disorders in pregnancy

A study of neurological disorders during pregnancy and puerperium

<b>Objective:</b> To study the clinical profile of patients presenting with primary and secondary neurological disorders during pregnancy and puerperium. <b> Materials and Methods:</b> This study was carried out at the Lady Harding Medical College between February 2004 and January 2005. All patients in pregnancy, postabortal or postpartum period attending to the Lady Harding Medical College between February 2004 and January 2005 and requiring neurological consultation were included in this study. Women with eclampsia were excluded. <b> Results: </b> There were 76 women included in this study (incidence of neurological disorders was 584 per 100,000 deliveries), with 46 cases of primary and 30 of secondary neurological disorders. The former included epilepsy (22), CNS infections (12), cerebrovascular disorders (9) [cerebral venous thrombosis - CVT (5), arterial infarctions (3) and haemorrhage (1)], CNS glioma (1), traumatic quadriparesis (1) and acute disseminated encephalomyelitis (1). The latter included hepatic encephalopathy [HE] (28), enteric encephalopathy (1) and critical illness polyneuropathy (1). In patients of epilepsy, the seizures had an equitable distribution in the trimesters and post-partum period, were mainly of generalized type (77.27%) and were controlled in the majority (90.9%). No fetal congenital malformations were seen. Tubercular meningitis [TBM] (7), pyogenic meningitis (4) and viral encephalitis (1) were the CNS infections encountered and pregnancy outcome was good in most cases. All cases of CVT presented in the postpartum period with fever and neurological signs following home delivery. Outcomes included recovery (2), residual deficits (1), persisting seizures (1) and death (1). HE affected patients mainly during the latter half of pregnancy or the post-partum period and was associated with 64.3% mortality. Death in HE showed correlation with grade of HE (<i> P</i> =0.007); Glasgow Coma Scale (<i> P</i> =0.006); Liver span (<i> P</i> =0.049); bilirubin (<i> P</i> =0.005) and retained foetus (<i> P</i> =0.044). <b> Conclusion:</b> The incidence of neurological disorders in pregnancy and puerperium was fairly high. Epilepsy and hepatic encephalopathy were the commonest primary and secondary neurological disorders, respectively.

Neurologic Disorders in Pregnancy

Neurologic Disorders in Pregnancy

Neurologic disorders in pregnancy

Neurologic dysfunction, coma, and seizures are common in obstetric patients in the intensive care unit. To review common neurologic disorders resulting in critical illness in pregnancy. Obstetric disorders causing coma and seizures include eclampsia, acute fatty liver of pregnancy, and amniotic fluid embolism. Preexisting disorders such as epilepsy may worsen in one-third of pregnant patients, and seizures are common during labor. Changes in hemodynamics, blood volume, and hormonal effects on the vessel wall increase risk of bleeding from berry aneurysms and arteriovenous malformations during pregnancy and the postpartum period. Acute intermittent porphyria produces seizures and hypertension, closely mimicking eclampsia. Cerebral venous sinus thrombosis is common in postpartum patients, especially in developing countries. Brain tumors invariably enlarge during pregnancy because of fluid retention and the presence of estrogen and progesterone receptors on tumor cells. Infections such as cerebral malaria and acute viral hepatitis with fulminant hepatic failure are common causes of coma and seizures during pregnancy in tropical regions of Asia, Africa, and Latin America. Patients may be admitted to the intensive care unit with type II respiratory failure due to myasthenic crisis, Guillain-Barre syndrome and spinal cord disease. Relapses of multiple sclerosis are infrequent during pregnancy but increase in the postpartum period. In all instances, the effects of the disorders, diagnostic tests, and treatment on the fetus must be carefully weighed. Prompt delivery may be lifesaving for mother and fetus in conditions such as eclampsia and acute fatty liver of pregnancy; expectant treatment may be more appropriate in others.

Neurologic Disorders in Pregnancy

European Journal of NeurologyVolume 12, Issue 4 p. 328-328 Neurologic Disorders in Pregnancy K. A. Jellinger, K. A. Jellinger Vienna, AustriaSearch for more papers by this author K. A. Jellinger, K. A. Jellinger Vienna, AustriaSearch for more papers by this author First published: 17 March 2005 https://doi.org/10.1111/j.1468-1331.2004.00905.xRead the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume12, Issue4April 2005Pages 328-328 RelatedInformation

Neurological disorders in pregnancy.

Neurological disorders are common in women of childbearing age and can lead to maternal death, as evident from previous reports of the Confidential Enquiry into Maternal Deaths in England and Wales. In the last report (1997-1999) alone, there were 34 deaths indirectly caused by neurological disorders. With the new developments in drugs, investigations and research, clinicians are now more able than ever before to diagnose and treat some disorders. A recent example is the French Study Group on Stroke in Pregnancy. This paper reviews the current concepts and outlines appropriate management of conditions such as epilepsy, headache, benign intracranial hypertension, myasthenia gravis, multiple sclerosis, Bell's palsy and cerebrovascular disorders.

7 High risk pregnancy

Summary An increasing number of women with significant medical disease are presenting to obstetricians for antenatal care. These pregnancies are recognized to be a major problem in obstetric practice, and the Confidential Enquiries into Maternal Deaths in the UK 1988–1990 ( HMSO, 1994 ) suggests that substandard care is provided in a high proportion of such pregnancies. The impact of pregnancy on pre-existing disease may be underestimated, and the relevant pathophysiology may be poorly understood. A multi-disciplinary approach to high risk pregnancy is strongly recommended. Our maternity unit has developed a system for identifying women with anaesthetic or medical risk factors at an early stage of pregnancy. The obstetric anaesthetist is then able to co-ordinate management with the obstetrician and relevant clinicians from other specialties. It is beyond the scope of this chapter to provide a comprehensive review of the management of all medical diseases in pregnancy. The topics discussed represent those most frequently presenting, and those in which management is controversial. The most commonly occurring high risk problems are obesity, asthma and diabetes. The management of diabetes in pregnancy has been well reviewed in recent literature ( Sibai, 1991 ; de Swiet, 1992 ; Ward and Douglas, 1993 ) and is not discussed in this chapter. Obesity is frequently not recognized as a risk factor in pregnancy, but was an associated factor in at least 12 reported deaths in the most recent Confidential Enquiries into Maternal Deaths in the UK ( HMSO, 1994 ). This chapter reviews the implications of obesity, asthma and cardiac disease in pregnancy. The management of musculoskeletal and neurological disorders in pregnancy are also discussed. It is hoped that an increased awareness of the impact of pre-existing medical disease on pregnancy will lead to a higher standard of antenatal and intrapartum care for these women.