Master Class

Stroke in Pregnancy and the Postpartum Period


 

In high-risk obstetrics, we are faced with a variety of critical presentations: threatened early pregnancy loss, pregnant patients with preexisting medical conditions, and the development of acute medical complications during pregnancy.

Fortunately, the most serious complications of pregnancy—seizures, myocardial infarctions, and cerebrovascular events—are rare.

Despite their infrequency, we must become sufficiently familiar with the presenting symptoms of these life-threatening complications of pregnancy to be able to employ our clinical skills at a moment's notice.

Recent advances in stroke management make quick action vital. Medications or surgery not only may save the lives of the woman and fetus, but may preserve brain function in the woman as well.

Very often, but not always, clues to the possibility of a stroke may lie in the woman's medical history of hypertension, preeclampsia, seizures, or a bleeding disorder.

We need to be alert to these risk factors for stroke, and make sure that we include stroke in the differential diagnosis even when the patient's symptoms may be masquerading as less serious complications of pregnancy.

This month, my guest Master Class professor is Baha Sibai, M.D., a world expert on hypertensive disorders and complications in pregnancy who has authored or coauthored more than 350 peer-reviewed publications on the topics of preeclampsia and eclampsia.

Dr. Sibai is professor and director of the department of obstetrics and gynecology at the University of Cincinnati. He formerly directed the division of maternal/fetal medicine at the University of Tennessee, Memphis.

DR. REECE, who specializes in maternal-fetal medicine, is the vice chancellor and dean of the college of medicine at the University of Arkansas in Little Rock.

E. ALBERT REECE, M.D., PH.D., M.B.A.

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