Strokes in new moms

Posted on 3 September 2014

A phenomenon we seldom hear about but that’s slowly on the increase worldwide, new moms can experience a mini-stroke up to 12 weeks after giving birth. But before you panic, Dr Peter Haug, a neurologist at Mediclinic Milnerton in Cape Town, gives us the facts to help allay your fears…

Case study: Khensani G* gave birth to a baby boy by caesarian on 14 January 2014. Three hours after her son was born, Khensi experienced an excruciating headache, lameness down her left side, her left eye started drooping shut and, 30 minutes later, she was battling to speak coherently. Her doctor determined she’d had a mild stroke. Treatment was started immediately and two weeks later, she and her son were discharged with a clean bill of health and, fortunately, no lasting damage.

Why do we not hear more about cases of post-partum strokes?
A recent review in the New England Journal of Medicine documented 248 cases of stroke in 1 687 930 deliveries, or 14 in 100 000 deliveries, which is probably why we don’t hear much about it.

What causes post-partum strokes?
A stroke after delivery can be caused by a blocked artery (ischaemic stroke), a clot in a cerebral vein (venous stroke) or a burst artery (haemorrhagic stroke). There seems to be slightly increased risk of stroke after cesarean delivery. According to the American Society of Haematology, doctors monitor women for blood clots more closely during pregnancy as their blood tends to clot more easily than at any other time. The risk of clotting is increased during late pregnancy and after delivery, which is caused by a change of coagulation factors. This can contribute to both arterial stroke as well as venous sinus thrombosis. Another rare complication associated with post-partum stroke is a weakening of the heart muscle (post-partum cardiomyopathy).

Who is most at risk of these strokes after delivery?
The risk of post-partum stroke is higher in patients suffering from diabetes and hypertension. There’s an elevated risk of hypertension and hypertensive complications in late pregnancy. Some women develop diabetes in pregnancy (gestational diabetes). Risk factors for both hypertension and diabetes include obesity, an age over 35 years, and epidemiological studies in America also highlighted an increased risk in Afro-Americans. Possible further risk factors for post-partum stroke include blood loss, blood transfusions, loss of fluid and electrolytes, low platelets (i.e. caused by HELLP syndrome, which is a complication similar to pre-eclampsyia, prior to delivery) and infection.

Any symptoms we should watch for?
Symptoms of an arterial stroke or intracranial haemorrhage are no different now than in the normal population, with the most common, frequently painless, symptoms being one-sided weakness, an explosive onset headache plus epileptic seizures, which can be a symptom of a clot in a cerebral vein. How devastating a stroke turns out to be depends on the location and amount of injured brain. Mortality and morbidity appears to be a higher in patients who had a burst artery, many patients recover well from venous stroke.

What are the best preventative measures new mom’s can take?
The best way to prevent a stroke in pregnancy and after delivery includes leading a healthy lifestyle, avoiding excessive weight gain in pregnancy, maintaining regular exercise, a healthy and balanced diet, avoiding cigarette smoke and alcohol, as well as regular screening for diabetes and hypertension. If you’re concerned that you may be at risk, speak to your doctor.

* Not her real name

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Published in Neurology

In the interest of our patients, in accordance with SA law and our commitment to expertise, Mediclinic cannot subscribe to the practice of online diagnosis. Please consult a medical professional for specific medical advice. If you have any major concerns, please see your doctor for an assessment. If you have any cause for concern, your GP will be able to direct you to the appropriate specialists.