Treatment tactics for pregnant women with hemorrhagic stroke

Abstract

Aim. To optimize delivery methods for pregnant women with hemorrhagic stroke.

Material and methods. The study included 41 pregnant women aged 20 to 40 years with haemorrhagic stroke. All women underwent a general clinical examination, a haemostasis study, computed tomography, magnetic resonance imaging, cerebral angiography, consultations with a neurologist, neurosurgeon, anaesthesiologist and ophthalmologist.

Results. Surgical intervention was required in 21 (51.2%) cases due to haemorrhage. The extent of the surgical intervention was as follows: - cranectomy with removal of intracerebral haematoma (IH) in 6 (28.6%) cases, osteoplastic trepanation with removal of IH in 3 (14.3%) pregnant women, trepanation with drainage of subacute and chronic IH in 4 (19. 1%), ventriculoperitoneostomy for occlusive hydrocephalus due to subarachnoid haemorrhage in 5 (23.7%) cases, and AA/AVM clipping in 3 (14.3%) of the remaining cases. Conservative management was performed in 20 (48.8%) cases. Residual effects of the transferred GI were observed in 22 (53.6%) women. Fundus examination revealed signs of intracranial hypertension in 18 (43.9%) pregnant women.

Conclusion. Optimisation of the management of pregnant women who have had a haemorrhagic stroke with the participation of a group of specialists, timely diagnosis, adequate treatment of cerebral pathology allows to avoid errors in medical and obstetrical management, maintain pregnancy and safely increase the frequency of delivery of these patients through the natural birth canal. Timely detection and adequate treatment of brain pathology help reduce errors during treatment and delivery, which, in turn, supports the preservation of the gestational period and ensures the birth of a viable child.