ABSTRACT

INTRODUCTION. Stroke is the fourth most common cause of death among all women and the eighth most common cause of pregnancy-related death. Despite the rare occurrence of stroke in pregnant women, this topic is of particular importance due to the severity of the pathology, disability of patients and increased maternal and perinatal mortality.

AIM. To analyze the literary sources of domestic and foreign authors describing the current understanding of the etiology, pathogenesis, clinic, diagnosis and treatment of stroke in pregnant women.

MATERIALS AND METHODS. An analysis of literature data for the period from 2015 to 2025 was conducted. Sources from the Russian scientific electronic library eLibrary, the RSCI databases, and PubMed were used.

RESULTS AND DISCUSSION. The article is devoted to the review of risk factors and causes of stroke development in pregnant women, clinical features of ischemic and hemorrhagic strokes, and diagnostic methods. The review considers various methods of pathology treatment depending on the type of acute cerebrovascular accident. Particular attention is paid to the interdisciplinary approach involving obstetricians-gynecologists, neurologists, neurosurgeons, cardiologists and anesthesiologists-resuscitators.

CONCLUSION. The conducted literature review shows that stroke in pregnant women is a rare, but extremely dangerous and complex clinical condition, which is a serious threat to both the mother and the fetus. It is important to note that the clinical picture is often masked by the symptoms of gestosis, preeclampsia and eclampsia, which complicates early diagnosis and increases the risk of complications. This pathology requires careful diagnosis and individualized treatment aimed at reducing the risk of complications and maintaining the health of the woman and child.

KEYWORDS: acute cerebrovascular accident, stroke, pregnancy

For citation: Raevskaya A.I., Ascatryan S.E., Lozovaya K.D., Vyshlova I.A. Stroke in Pregnant Women: Etiology, Pathogenesis, Clinical Picture, Modern Methods of Diagnostics and Therapy: a Review. Comorbidity Neurology. 2025; 2 (3): 60-65. https://doi.org/10.62505/3034-185x-2025-2-3-60-65

*Для correspondence: Anastasia I. Raevskaya, Assistant of the Department of Neurology, Neurosurgery and Medical Genetics, Stavropol State Medical University, Stavropol, Russia, e-mail: nastya_raevskaya96@mail.ru

REFERENCES

1.Opaskar A., Massaquoi R., Sila C. Stroke in pregnancy. Handb Clin Neurol. 2021; 177: 283-293. https://doi.org/10.1016/B978-0-12-819814-8.00032-9

2.Sanders B.D., Davis M.G., Holley S.L., Phillippi J.C. Pregnancy-Associated Stroke. J Midwifery Womens Health. 2018; 63 (1): 23-32. https://doi.org/10.1111/jmwh.12720

3.Bayanduryan E.A., Samburova N.V., Anichkova E.V., Shkoda A.S., Bitsadze V.O. Etiopathogenetic risk factors for stroke in pregnant women. Obstetrics, Gynecology and Reproduction. 2019; 13 (3): 217–226. https://doi.org/10.17749/2313-7347.2019.13.3.217-226 (In Russ.)

4.Beal C.C., Faucher M.A. Stroke and pregnancy: an integrative review with implications for neuroscience nurses. J Neurosci Nurs. 2015; 47 (2): 76-84. https://doi.org/10.1097/JNN.0000000000000119

5.Ban L., Sprigg N., Abdul Sultan A., Nelson-Piercy C., Bath P.M., Ludvigsson J.F., Stephansson O., Tata L.J. Incidence of First Stroke in Pregnant and Nonpregnant Women of Childbearing Age: A Population-Based Cohort Study From England. J Am Heart Assoc. 2017; 6 (4): e004601. https://doi.org/10.1161/JAHA.116.004601

6.Enomoto N., Tanaka H., Katsuragi S., Hayata E., Hasegawa J., Nakata M., Takahashi J.C., Sekizawa A., Ishiwata I., Ikeda T. Pregnancy-associated hemorrhagic stroke: A nationwide survey in Japan. J Obstet Gynaecol Res. 2021; 47 (6): 2066-2075. https://doi.org/10.1111/jog.14786

7.Ozturk S. Stroke and Stroke Risk Factors as Disease Burden. Health Risk Analysis. 2021; 4: 146-151. https://doi.org/10.21668/health.risk/2021.4.16 (In Russ.)

8.Reddy M., Vazquez S., Nolan B., Clare K., Feldstein E., Medicherla C., Kaur G., Rostanski S.K., Czap A.L., Li J., Gandhi C.D., Al-Mufti F. Migraine and its Association with Stroke in Pregnancy: A National Examination. J Womens Health (Larchmt). 2024; 33 (11): 1476-1481. https://doi.org/10.1089/jwh.2023.1136

9.Verovskaya T.A., Podobed N.D., Bramnik I.V. Organization of Medical Care for Pregnant Women With Acute Cerebrovascular Accident in the Volgograd Region. Chief Physician of the South of Russia. 2019; 1 (65): 9-12 (In Russ.)

10.Taitubaeva G.K., Petrova E.V., Gribacheva I.A. Ischemic stroke in pregnant women. The Eurasian Union of Scientists. 2017; 10–1 (43): 1–4. (In Russ.)

11.Kulesh A.A., Demin D.A., Vinogradov O.I. Pathogenetic Mechanisms of Ischemic Stroke: From Verification to Secondary Prevention. Consilium Medicum. 2021; 23 (11): 792-799. https://doi.org/10.26442/20751753.2021.11.201153 (In Russ.)

12.Yew K.S., Cheng E.M. Diagnosis of acute stroke. Am Fam Physician. 2015; 91 (8): 528-36

13.Srailova K.B., Raimkulov B.N., Nurguzhaev E.S., Raimkulova H.B. Pathogenesis, clinical manifestations of strokes, treatment. Uzbek Journal of Case Reports. 2023; 3: 39-42 (In Russ.)

14.Shah R.K., Jaiswal A., Mushtaq R., Ansari S., Deep J.P. Stroke in Pregnancy: A Case Report. JNMA J Nepal Med Assoc. 2023; 61 (260): 383-386. https://doi.org/10.31729/jnma.8112

15.Svobodová N., Kaščák P., Bojda M. Haemorrhagic Stroke in Pregnancy. Ceska Gynekol. 2024; 89 (2): 108-112. English. https://doi.org/10.48095/cccg2024108

16. Arustamyan R.R., Adamyan L.V., Shifman E.M., Konysheva O.V., Doroshenko D.A., Lukina N.N., Golonzko V.A., Lapochkina O.B. The Acute Disorders of Cerebral Blood Circulation of Ischemic Type During Pregnancy, Delivery and Post-Delivery Period. Russian Medicine. 2017; 23 (5): 242–247. https://doi.org/10.18821/0869-2106-2017-23-5-242-247 (In Russ.)

17. Petrov M.G., Kucherenko S.S., Topuzova M.P. Hemorrhagic transformation of ischemic stroke. Arterial Hypertension. 2021; 27 (1): 41-50. https://doi.org/10.18705/1607-419X-2021-27-1-41-50 (In Russ.)

18. Gama M.D.P., Angelo Júnior J.R.L, Cunha-Correia C.D. Stroke in COVID-19 and Pregnancy: A Case Report. Rev Soc Bras Med Trop. 2021; 54: e03012021. https://doi.org/10.1590/0037-8682-0301-2021

19.Eliseev E.V., Doroshenko D.A., Averkov O.V., Konysheva O.V., Kamchatnov P.R., Zubarev A.R. Difficulties in the Diagnosis of Stroke in Pregnant Women. S.S. Korsakov Journal of Neurology and Psychiatry. 2017; 117 (3‑2): 20‑25. https://doi.org/10.17116/jnevro20171173220-25  (In Russ.)

20. Diagnosis and Management of Transient Ischemic Attack. Coutts SB. Continuum (Minneap Minn). 2017; 23 (1, Cerebrovascular Disease): 82-92. https://doi.org/10.1212/CON.0000000000000424 

21. Omran S.S., Zhang C., Seitz A., Bruce S.S., Liao V., Pawar A., Navi B.B., Kamel H., Liberman A.L. Possible misdiagnosis of pregnancy-associated stroke in the emergency department. J Stroke Cerebrovasc Dis. 2025; 34 (1): 108139. https://doi.org/10.1016/j.jstrokecerebrovasdis.2024.108139

22. Nukovic J.J., Opancina V., Ciceri E., Muto M., Zdravkovic N., Altin A., Altaysoy P., Kastelic R., Velazquez Mendivil D.M., Nukovic J.A., Markovic N.V., Opancina M., Prodanovic T., Nukovic M., Kostic J., Prodanovic N. Neuroimaging Modalities Used for Ischemic Stroke Diagnosis and Monitoring. Medicina (Kaunas). 2023; 59 (11): 1908. https://doi.org/10.3390/medicina59111908 

23. Nentwich L.M. Diagnosis of Acute Ischemic Stoke. Emerg Med Clin North Am. 2016; 34 (4): 837-859. https://doi.org/10.1016/j.emc.2016.06.008

24.Doiron T., Ramseyer A., Phelps E.N., Williams A.J., Teal L.N., Hollenbach L.L., Magann E.F. Pregnancy-Related Stroke: A Review. Obstet Gynecol Surv. 2022; 77 (6): 367-378. https://doi.org/10.1097/OGX.0000000000001039

25. Wiącek M., Oboz-Adaś A., Kuźniar K., Karaś A., Jasielski P., Bartosik-Psujek H. Acute Ischemic Stroke in Pregnancy : a Practical Focus on Neuroimaging and Reperfusion Therapy. Clin Neuroradiol. 2023; 33 (1): 31-39. https://doi.org/10.1007/s00062-022-01215-5

26. Shamsutdinova A.G., Iskakova F.E., Polatbekov A.A., Mamyrbekova S.A. Current Status of Care in Ischemic Stroke: Literature Review. West Kazakhstan Medical Journal. 2023; 65 (1): 19-28. https://doi.org/10.24412/2707-6180-2023-65-19-28 (In Russ.)

27. Katsafanas C., Bushnell C. Pregnancy and Stroke Risk in Women. Neurobiol Dis. 2022; 169: 105735. https://doi.org/10.1016/j.nbd.2022.105735

28. Camargo E.C., Singhal A.B. Stroke in Pregnancy: A Multidisciplinary Approach. Obstet Gynecol Clin North Am. 2021; 48 (1): 75-96. https://doi.org/10.1016/j.ogc.2020.11.004

29. Wang A., Saad A.F. Hemorrhagic Stroke in Pregnancy. Clin Obstet Gynecol. 2023; 66 (1): 223-230. https://doi.org/10.1097/GRF.0000000000000739

30. Garg A., Roeder H., Leira E.C. In-hospital outcomes and recurrence of stroke during pregnancy and puerperium. Int J Stroke. 2023; 18 (4): 445-452. https://doi.org/10.1177/17474930221116209

31. Verho L., Tikkanen M., Äyräs O., Aarnio K., Rantanen K., Korhonen A., Richardt A., Laivuori H., Gissler M., Ijäs P. Pregnancy-associated stroke and the recurrence of stroke and other complications in subsequent pregnancies: Population-based retrospective cohort study. BJOG. 2023; 130 (11): 1421-1429. https://doi.org/10.1111/1471-0528.17503

ADDITIONAL INFORMATION

Anastasia I. Raevskaya, Assistant of the Department of Neurology, Neurosurgery and Medical Genetics, Stavropol State Medical University, Stavropol, Russia. E-mail: nastya_raevskaya96@mail.ru. ORCID: https://orcid.org/0000-0002-4084-3307

Sofia E. Ascatryan, Student of Medicine Faculty, Stavropol State Medical University, Stavropol, Russia. E-mail: astsatryan.sofiya@mail.ru. ORCID: https://orcid.org/0009-0005-7377-8686

Kseniya D. Lozovaya, Student of Medicine Faculty, Stavropol State Medical University, Stavropol, Russia. E-mail: lozovaya.kseniia@yandex.ru. ORCID: https://orcid.org/0009-0003-1623-4530

Irina A. Vyshlova, Dr. Sci. (Med.), Professor of the Department of Neurology, Neurosurgery and Medical Genetics Stavropol State Medical University, Stavropol, Russia. E-mail: irisha2801@yandex.ru. ORCID: https://orcid.org/0000-0001-9187-8481

Author contributions. All authors confirm the compliance of their authorship, according to international ICMJE criteria (all authors made a significant contribution to the development of the concept, research and preparation of the article, read and approved the final version before publication). Special contributions: Raevskaya A.I. – conceptualization, methodology; Ascatryan S.E. – formal analysis, writing – original draft; Lozovaya K.D. –formal analysis; Vyshlova I.A. – supervision, project administration, writing – review & editing.

Funding. This study was not supported by any external sources of funding.

Disclosure. The authors declare no apparent or potential conflicts of interest related to the publication of this article.

The content is available under the Creative Commons Attribution 4.0 License.

©2025. Anastasia I. Raevskaya, Sofia E. Ascatryan, Kseniya D. Lozovaya, Irina A. Vyshlova