title: Maternal death from stroke: a thirty year national retrospective review.
abstract: OBJECTIVE
  In the United Kingdom (UK), the maternal mortality rate from stroke is reported at 0.3/100,000 deliveries, but only antenatal data have previously been reviewed. We hypothesise that the true rate is much higher due to a propensity for stroke occurring in the post-partum period, and that the rate will rise in parallel with trends of increasing maternal age and medical co-morbidities. Our objectives are to investigate the UK stroke mortality rate in pregnancy and the puerperium, and to examine temporal changes in fatal maternal strokes over a 30 year period.
  
  
  METHODS
  Retrospective review of stroke-related maternal deaths reported to the UK confidential enquiries into maternal death between 1979 and 2008, encompassing 21,514,457 maternities. In accordance with the ICD.10 classification, cases were divided into direct or indirect deaths. Late and coincidental deaths were not included in analyses. Lessons from sub-standard care associated with maternal death from stroke were collated.
  
  
  RESULTS
  In 1979-2008 there were 347 maternal deaths from stroke: 139 cases were direct deaths, i.e. the fatal stroke was a direct result of pregnancy. The incidence of fatal stroke is relatively constant at 1.61/100,000 maternities, with a 13.9% (95% CI 12.6-15.3) proportional mortality rate. Intracranial haemorrhage was the single greatest cause of maternal death from stroke.
  
  
  CONCLUSIONS
  This is the largest UK study examining the incidence of fatal maternal stroke in pregnancy and the puerperium. Our results highlight the high proportion of women who die from stroke in the puerperium. Sub-standard care featured especially in regard to management of dangerously high systolic blood pressure levels. These deaths highlight the importance of education in managing rapid-onset hypertension and superimposed coagulopathies.
authors.affiliation: Department of Obstetrics and Gynaecology, Queen Charlotte's and Chelsea Hospital, Du Cane Road, London W12 0HS, United Kingdom.
authors.forename: Lin
authors.initials: L
authors.lastname: Foo
authors.forename: Susan
authors.initials: S
authors.lastname: Bewley
authors.forename: Anthony
authors.initials: A
authors.lastname: Rudd
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D020300:Intracranial Hemorrhages / Q000401:mortality; D008423:Maternal Age; D008428:Maternal Mortality; D049590:Postpartum Period; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000401:mortality*; D011644:Puerperal Disorders / Q000401:mortality*; D012189:Retrospective Studies; D020521:Stroke / Q000401:mortality*; D013345:Subarachnoid Hemorrhage / Q000401:mortality; D006113:United Kingdom / Q000453:epidemiology
keywords: Cerebro-vascular accident; Maternal mortality; Stroke in young adults