Pregnancy Outcomes in Women With Current or Previous Cerebrovascular Accident
ACOG ePoster. Bushman E. Apr 27, 2018; 212063; 35L
Elisa Bushman
Elisa Bushman
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Abstract
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Introduction: To describe presence of cerebrovascular accident (CVA) risk factors and obstetric outcomes in women with pregnancy associated stroke (PAS), and to describe management and outcomes of subsequent pregnancies in women with history of CVA.

Methods: In a population of 948,074 births women with history of CVA during pregnancy or followed by subsequent pregnancy were identified by ICD-9 and 10 codes. CVA types were categorized as ischemic, hemorrhagic, and transient ischemic event. Major CVA and known pregnancy risk factors for PAS were abstracted. Use of thromboprophylaxis, pregnancy outcomes, and presence of recurrent CVA were abstracted.

Results: 61 patients were identified with PAS; 51% antepartum and 78% ischemic CVA predominance was found. Thrombophilia was present in 6%, and 27% had concomitant gestational hypertensive disease. 69% of women delivered at term.
102 patients were identified with history of CVA (88 patients) or PAS (14 patients) who underwent subsequent pregnancy. Women with previous PAS were more likely to be Hispanic (25% vs 10% P=.024). 31% of women with history of PAS received thromboprophylaxis in subsequent pregnancies compared to 61% of women with previous CVA (P=.069). There were six cases of recurrent CVA giving a 5.7% risk of recurrence.


Conclusion/Implications: PAS is most commonly ischemic (78%) and is concomitant with hypertensive disease of pregnancy in 27% of cases. Pregnancy outcomes are overall positive if extreme prematurity is avoided. Recurrent CVA occurs in 5.7% of women who pursue future pregnancy, and thus management of these pregnancies remains high risk.
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