December 8, 2020

By Emeline Mugisha, M.S.N., M.P.H., R.N

Although stroke is a leading cause of death and disability in the U.S., it rarely affects women during the postpartum period. The most recent nationwide study from 2000-2001 found that the risk of pregnancy-related stroke is 34.2 per 100,000 deliveries. That is, strokes affect less than 0.1% of U.S. women during and after pregnancy. Still, learning about this complication is essential as a stroke may be a potentially life-changing event, and knowing the warning signs can save lives.

What is a stroke?

A stroke is a brain injury and medical emergency that occurs when there is a problem with your brain's normal blood flow. When our brain cells do not receive the oxygen and nutrients from our blood that they need to survive, they begin to die within minutes. This event is known as a stroke, and it may cause long-term brain damage, chronic disability, or death.

There are two main types of strokes: ischemic and hemorrhagic.

The most common type is an ischemic stroke, which occurs when a blood clot or plaque (the buildup of fatty substances in your arteries) prevents blood flow to the brain. This blockage may either develop in an artery leading to your brain (cerebral thrombosis) or break off elsewhere in the body and then travel to your brain (cerebral embolism).

A hemorrhagic stroke is less common. It occurs when a blood vessel breaks and bleeds into the brain (intracerebral hemorrhage) or on the brain's surface (subarachnoid hemorrhage). With either kind of hemorrhage, bleeding may take place slowly or quickly and without warning.

Research suggests that the risk of ischemic stroke and intracerebral hemorrhage increases during pregnancy and after childbirth, although estimates vary widely across studies.

What are the symptoms of a stroke?

Stroke symptoms vary depending on the type and location of the brain injury. For example, ischemic strokes caused by a cerebral embolism often have no warning signs. However, in most cases, people who experience a stroke show one or more of the following changes:

• Sudden numbness or weakness, usually on one side of the body
• Sudden confusion, trouble speaking, or trouble understanding speech
• Sudden trouble seeing in one or both eyes
• Sudden trouble walking, dizziness, loss of balance, or loss of coordination
• Sudden severe headache without a known cause

The “F.A.S.T." test is a quick way to check if someone may be showing the warning signs of a stroke. It uses letters to help people recognize the most common stroke symptoms and know when to call 9-1-1. Using "F.A.S.T." can help identify most—but not all—strokes:

• Face: Ask the person to smile. Is their smile uneven or weak on one side?
• Arms: Ask the person to raise both arms. Does one arm drop down?
• Speech: Ask the person to repeat a simple sentence. Are they unable to speak or hard to understand?
• Time: If the answer is “yes” to any of these warning signs, even if the problem goes away, call 9-1-1 immediately. Treatment is most effective when it starts quickly.

What are the risk factors for postpartum stroke?

Many of the significant risk factors for postpartum stroke are the same as those in the general population. Some of the risk factors linked specifically to postpartum stroke include:

• Pre-existing medical conditions such as chronic high blood pressure (hypertension), diabetes, heart and blood vessel diseases, lupus, and sickle cell disease
• Pregnancy-related hypertension disorders such as pre-eclampsia
• A longer length of hospitalization after childbirth
• Maternal age greater than 35 years
• African-American ethnicity
• Cesarean delivery
• Tobacco use

How is a postpartum stroke treated?

Postpartum stroke has the same treatment approach as stroke in the general population. Stroke treatment requires emergency medical care. The goal of treatment is to reduce or prevent brain injury so that the person restores as much of their health as possible.

At the hospital, you will receive care from a team of health professionals. A specialist such as a neurologist (a doctor who treats brain disorders) will most likely work with you as part of this team. Your providers will ask about your health history and your current symptoms. They will also perform brain scans to determine whether you had an ischemic or hemorrhagic stroke.

Treatment may include a combination of medications, surgery, or other medical procedures to help break up clots or stop the bleeding in your brain. Your treatment plan will depend on the type of stroke you had, how long ago your symptoms started, and your health history.

For example, if you arrive at the hospital within three hours of the first signs of an ischemic stroke, you can receive emergency medications to break up blood clots.

DeKoninck, P. L. J., Pijnenborg, J. M. A., van Zutphen, S. W., & Arnoldus, E. P. J. (2008). Postpartum stroke, a diagnostic challenge. The American Journal of Emergency Medicine, 26(7), 843.e3-4. doi:http://ezproxy.acu.edu:2082/10.1016/j.ajem.2008.01.045

James, A. H., Bushnell, C. D., Jamison, M. G., & Myers, E. R. (2005). Incidence and risk factors for stroke in pregnancy and the puerperium. Obstetrics and Gynecology, 106(3), 509–516. https://doi.org/10.1097/01.AOG.0000172428.78411.b0

National Heart, Lung, and Blood Institute. (n.d.) Stroke. https://www.nhlbi.nih.gov/health-topics/stroke

Tate, J., & Bushnell, C. (2011). Pregnancy and stroke risk in women. Women’s Health (London, England), 7(3), 363–374. https://doi.org/10.2217/whe.11.19

Too, G., Wen, T., Boehme, A. K., Miller, E. C., Leffert, L. R., Attenello, F. J., Mack, W. J., DʼAlton, M. E., & Friedman, A. M. (2018). Timing and risk factors of postpartum stroke. Obstetrics and Gynecology, 131(1), 70–78. https://doi.org/10.1097/AOG.0000000000002372



Emeline Mugisha, M.S.N., M.P.H., R.N. - Emeline Mugisha is an award-winning, master's-prepared nurse with over a decade of experience in community/public health and clinical health services at the field and management levels. She has co-authored two professional manuscripts in Women's Health Issues and the Journal of Midwifery and Women's Health. She has an M.S. in Public Health Nursing and an M.P.H. from Johns Hopkins University.