title: Maternal Death Due to Stroke Associated With Pregnancy-Induced Hypertension.
abstract: BACKGROUND
  The aim of this study was to clarify the clinical features of maternal death due to stroke associated with pregnancy-induced hypertension (PIH) in Japan.
  
  
  RESULTS
  Reported maternal deaths occurring between 2010 and 2012 throughout Japan were analyzed by the Maternal Death Exploratory Committee. Among a total of 154 reports of maternal death, those due to stroke with (n=12) or without (n=13) PIH were compared. Cerebral stroke occurred more frequently in the third trimester and during the second stage of labor in deaths with PIH, whereas it occurred at any time point in deaths not involving PIH. Although 83% of patients with PIH who died had experienced initial symptoms in a hospital, more than half of them required maternal transport due to lack of medical resources. Among the patients without PIH, some vascular abnormalities were identified, but no evidence was found among the patients with PIH. In addition, 58% of PIH cases resulting in stroke were complicated by hemolysis, elevated liver enzymes and low platelet count (HELLP) syndrome.
  
  
  CONCLUSIONS
  Appropriate management of PIH during pregnancy and labor, including anti-hypertensive therapy and early maternal transport to tertiary hospital, may reduce the maternal death rate.
authors.affiliation: Department of Obstetrics and Gynecology, Showa University School of Medicine.
authors.forename: Junichi
authors.initials: J
authors.lastname: Hasegawa
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Ikeda
authors.forename: Akihiko
authors.initials: A
authors.lastname: Sekizawa
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Tanaka
authors.forename: Masahiko
authors.initials: M
authors.lastname: Nakata
authors.forename: Takeshi
authors.initials: T
authors.lastname: Murakoshi
authors.forename: Shinji
authors.initials: S
authors.lastname: Katsuragi
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Osato
authors.forename: Isamu
authors.initials: I
authors.lastname: Ishiwata
authors.forename: Katsuyuki
authors.initials: K
authors.lastname: Kinoshita
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D046110:Hypertension, Pregnancy-Induced / Q000097:blood* / Q000401:mortality*; D008875:Middle Aged; D036801:Parturition; D011247:Pregnancy; D011263:Pregnancy Trimester, Third; D020521:Stroke / Q000097:blood* / Q000209:etiology / Q000401:mortality*