title: Factors contributing to mortality and morbidity in pregnancy-associated intracerebral hemorrhage in Japan.
abstract: OBJECTIVE
  The aim of this study was to analyze the causes and outcomes for intracerebral hemorrhage (ICH) occurring during pregnancy and postnatally.
  
  
  METHODS
  A nationwide study of pregnancy-related ICH in Japan was performed. We contacted 1582 facilities to identify women with ICH in pregnancy or postnatally between 1 January 2006 and 31 December 2006. A total of 1012 facilities (70%) responded with completed questionnaires. Risk factors for ICH, neurological features, onset to diagnosis time (O-D time), and obstetric data were recorded.
  
  
  RESULTS
  Thirty-eight cases of pregnancy-associated ICH were identified, corresponding to 3.5 per 100 000 deliveries. There were seven maternal deaths, giving a case mortality rate of 18.4%. Pre-eclampsia was identified in 10 cases (26.3%) and hemolysis elevated liver enzymes and low platelet count (HELLP) syndrome was present in five. There were four cases (10.5%) with Moyamoya disease and seven (18.4%) with arteriovenous malformation. HELLP syndrome and moderately or severely disturbed consciousness at disease onset were significantly associated with a poor outcome (modified Rankin Scale ≥3). Pre-eclampsia, HELLP syndrome and O-D time >3 h were significantly associated with maternal mortality.
  
  
  CONCLUSIONS
  Early diagnosis may prevent maternal death, even in severe cases of pregnancy-related ICH. However, maternal-fetal care centers do not always have full-time neurosurgeons or diagnostic imaging tools suitable for diagnosis of ICH. Thus, a network should be established between maternity centers and neurosurgery departments with computed tomography or magnetic resonance imaging available at all times. We recommend transferal of pregnant women with neurological symptoms to a regional facility that is equipped to treat such patients.
authors.affiliation: Department of Perinatology and Gynecology, National Cerebral and Cardiovascular Center, Osaka, Japan.
authors.forename: Jun
authors.initials: J
authors.lastname: Yoshimatsu
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Ikeda
authors.forename: Shinji
authors.initials: S
authors.lastname: Katsuragi
authors.forename: Kazuo
authors.initials: K
authors.lastname: Minematsu
authors.forename: Kazunori
authors.initials: K
authors.lastname: Toyoda
authors.forename: Kazuyuki
authors.initials: K
authors.lastname: Nagatsuka
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Naritomi
authors.forename: Susumu
authors.initials: S
authors.lastname: Miyamoto
authors.forename: Koji
authors.initials: K
authors.lastname: Iihara
authors.forename: Haruko
authors.initials: H
authors.lastname: Yamamoto
authors.forename: Yasumasa
authors.initials: Y
authors.lastname: Ohno
mesh_terms: D000328:Adult; D002543:Cerebral Hemorrhage / Q000401:mortality*; D005260:Female; D017359:HELLP Syndrome / Q000401:mortality; D006801:Humans; D009017:Morbidity; D011225:Pre-Eclampsia / Q000401:mortality; D011247:Pregnancy; D011248:Pregnancy Complications / Q000401:mortality*
keywords: cerebrovascular disease; morbidity; mortality; postnatally; pregnancy