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Factors contributing to mortality and morbidity in pregnancy‐associated intracerebral hemorrhage in J apan
Author(s) -
Yoshimatsu Jun,
Ikeda Tomoaki,
Katsuragi Shinji,
Minematsu Kazuo,
Toyoda Kazunori,
Nagatsuka Kazuyuki,
Naritomi Hiroaki,
Miyamoto Susumu,
Iihara Koji,
Yamamoto Haruko,
Ohno Yasumasa
Publication year - 2014
Publication title -
journal of obstetrics and gynaecology research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.597
H-Index - 50
eISSN - 1447-0756
pISSN - 1341-8076
DOI - 10.1111/jog.12336
Subject(s) - medicine , hellp syndrome , intracerebral hemorrhage , pregnancy , eclampsia , obstetrics , pediatrics , glasgow coma scale , surgery , genetics , biology
Aim The aim of this study was to analyze the causes and outcomes for intracerebral hemorrhage ( ICH ) occurring during pregnancy and postnatally. Material and Methods A nationwide study of pregnancy‐related ICH in J apan was performed. We contacted 1582 facilities to identify women with ICH in pregnancy or postnatally between 1 J anuary 2006 and 31 D ecember 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 M oyamoya 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. Conclusion 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.