title: Maternal and perinatal outcome in women with a history of stroke.
abstract: OBJECTIVE
  The purpose of this study was to determine recurrence risk and pregnancy outcome in 23 women with a history of stroke.
  
  
  METHODS
  We conducted a descriptive study of 23 women (35 pregnancies) with a history of stroke. Charts were reviewed from 1990 through 2002. The data were analyzed for the antenatal treatment strategies, recurrence risk for stroke, and pregnancy outcome.
  
  
  RESULTS
  There were 23 study patients with 35 subsequent pregnancies. Associated risk factors of the stroke were thrombophilia (5 women), sickle cell disease (3 women), maternal cardiac malformations (3 women), hypertension (3 women), oral contraceptive use (2 women), cerebral arteriovenous malformations (2 women), head trauma (1 woman), meningitis (1 woman), endocarditis (1 woman), and idiopathic reason (2 women). Four women with 9 subsequent pregnancies had a stroke that was associated with a previous pregnancy or postpartum incident. Two of these 9 pregnancies received anticoagulation (heparin, 1 pregnancy; heparin plus aspirin, 1 pregnancy). Nineteen women with 26 subsequent pregnancies had a stroke before pregnancy. Nine of these 26 pregnancies received anticoagulation (heparin, 5 pregnancies; aspirin, 3 pregnancies; heparin plus aspirin, 1 pregnancy). The remaining pregnancies did not receive prophylactic anticoagulation. Overall, there were 21 term deliveries, 8 preterm deliveries, 5 miscarriages, and 1 fetal death. Three of 34 pregnancies (9%) were small for gestational age infants. There were no recurrent thrombotic episodes during pregnancy or after delivery. Maternal complications included admission to the intensive care unit for uncontrolled hypertension in 1 patient.
  
  
  CONCLUSIONS
  Women with a history of stroke have a low risk of recurrent stroke (0%). This information is useful for the prepregnancy counseling of such individuals. The need for prophylactic anticoagulation in patients with a previous stroke cannot be answered by this study.
authors.affiliation: Department of Obstetrics and Gynecology, University of Cincinnati, Cincinnati, Ohio 45267-0526, USA.
authors.forename: Kristin H
authors.initials: KH
authors.lastname: Coppage
authors.forename: Andrea C
authors.initials: AC
authors.lastname: Hinton
authors.forename: Julie
authors.initials: J
authors.lastname: Moldenhauer
authors.forename: Oormila
authors.initials: O
authors.lastname: Kovilam
authors.forename: John R
authors.initials: JR
authors.lastname: Barton
authors.forename: Baha M
authors.initials: BM
authors.lastname: Sibai
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D005313:Fetal Death; D005500:Follow-Up Studies; D005865:Gestational Age; D006801:Humans; D020766:Intracranial Embolism / Q000150:complications / Q000175:diagnosis; D010298:Parity; D018743:Perinatal Care; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000175:diagnosis* / Q000453:epidemiology; D011256:Pregnancy Outcome; D018566:Pregnancy, High-Risk; D011644:Puerperal Disorders / Q000453:epidemiology / Q000209:etiology; D012307:Risk Factors; D012494:Sampling Studies; D020521:Stroke / Q000150:complications / Q000175:diagnosis*