Background: Pregnancy-associated stroke (PAS) is a neurological emergency, and unless recognised, morbidity and mortality are inevitable. There are known risk factors like maternal age, conception following assisted reproductive technologies, anaemia, underlying thrombophilia and caesarean delivery, but hypertension is one of the recognised common causes during pregnancy and postpartum, thus it has a huge impact in developing countries.
Methods: A retrospective descriptive study was conducted at a tertiary care centre in southern India. All women who were admitted with signs or symptoms of stroke either during pregnancy or postpartum up to 6 weeks in the last 10 years were included.
Results: Of the total 57 women with PAS, the majority occurred in the postpartum period (79%). Only 10% of them were of maternal age 35 and above. The first three weeks after delivery had the highest risk, with almost 40% of deliveries occurring at term. Hypertension and caesarean delivery were the common risk factors (36.8%). Hypertension was non-severe in 60% of them. Hyperemesis was the commonest risk factor in the first trimester. Haemorrhagic stroke was seen in only 12%, and thrombosis in the sigmoid and transverse sinus was the commonest finding on imaging. The fatality rate was 20%. The symptoms were not recognised as red flags in almost 30% of cases at initial presentation, resulting in delayed referral.
Conclusion: Hospitals should use appropriate risk assessment protocols for thromboprophylaxis during pregnancy and the postpartum period. The majority of the PAS had preventable risk factors and non-severe hypertension after delivery needs appropriate follow-up.