According to CDC, there has been a 54 percent increase in the number of pregnant women who’ve had strokes in 1995 to 1996 and in 2005 to 2006. While this may surprise some researchers, it certainly would not surprise clinicians who take care of pregnant women who have risk factors such as obesity, chronic hypertension or a lack of prenatal care. Ten percent of strokes occur in the first trimester, 40 percent during the second trimester and more than fifty percent occur during the post partum period and after the patient has been discharged home. Hypertension was the cause of one-third of stroke victims during pregnancy and fifty percent in the post partum period. Hypertension accounted for one-third of stroke cases during pregnancy and fifty percent in the post partum period. Many stroke cases might be prevented if blood pressure problems were treated appropriately during pregnancy.
Pregnant women who have high blood pressure during the first trimester are treated with medication and are classified as having chronic hypertension. The problem occurs when patients begin their prenatal care late and have high blood pressure or when a diagnosis of pre-eclampsia is missed. Pre-eclampsia is a clinical condition that includes high blood pressure, protein in the urine and swelling of the hands, face, ankle or feet. Should patients be treated with medication or should their babies be delivered? The diagnosis may not be straight forward. The patient’s blood pressure could be high but there’s no protein in the urine. Or the patient may have high blood pressure that returns to normal with bed rest. Or the patient is only 26 or 27 weeks but has high blood pressure and a diagnosis of pre-eclampsia but the practitioner is hesitant to deliver the baby based on its prematurity. Or the patient is hospitalized for high blood pressure and then the blood pressure returns to “normal” so the healthcare provider inadvertently sends the patient home. Or the patient had high blood pressure, delivered a baby, is sent home and then has a seizure and ultimately a stroke.
What should a pregnant mom do to prevent a stroke? If you have blood pressure problems during your pregnancy, insistent on obtaining a consultation from a high-risk obstetrician (aka maternal fetal medicine specialist) even if you think your present obstetrician or midwife is managing your prenatal care appropriately. A second opinion never hurts and in some cases, it can save a life. Two heads are always better than one.
*This blog post was originally published at Dr. Linda Burke-Galloway*