Elsevier

Critical Care Clinics

Volume 32, Issue 1, January 2016, Pages 43-59
Critical Care Clinics

Neurologic Complications in Pregnancy

https://doi.org/10.1016/j.ccc.2015.08.002Get rights and content

Section snippets

Key points

  • This article discusses the neurologic complications during pregnancy.

  • This article analyzes and summarizes the most recent data about stroke, eclampsia, status epilepticus, neuromuscular disease, and brain death during pregnancy.

  • This article emphasizes the physiopathology, epidemiology, and modality of treatments of the previously mentioned conditions.

Preeclampsia-eclampsia

Preeclampsia (PREC) is defined as the constellation of newly diagnosed hypertension (systolic/diastolic blood pressure [BP] ≥140/90 mm Hg on 2 occasions at least 4 hours apart after 20 weeks’ gestation in a woman with previously normal BP; or BP ≥160/110 mm Hg, confirmed within a few minutes to facilitate timely antihypertensive treatment) and proteinuria (>300 mg/24 h or ≥1+ in dipstick testing; because of variability of qualitative determinations, this method is discouraged for diagnostic use

Hemolysis, elevated liver enzyme levels, and low platelet levels syndrome

The hemolysis, increased liver enzyme levels, and low platelet levels syndrome is a laboratory defined severe form of PREC. The acronym stands for hemolysis (anemia, increased bilirubin level, schistocytes in blood smear), increased liver enzyme levels (AST or ALT >70 U/L), and low platelet levels (<100,000/mm3). It is associated with poor maternal (0%–24%) and perinatal (8%–60%) mortality caused by multisystem involvement. The incidence has been reported as 4% to 12% of patients with severe

Myasthenia gravis

Myasthenia gravis (MG) is an autoimmune disorder of the neuromuscular junction, commonly affecting women in their third decade of life, who are of childbearing age.36

Guillain-Barré syndrome

Guillain-Barré syndrome (GBS), or acute inflammatory demyelinating polyradiculoneuropathy (AIDP), is the most common cause of acute neuromuscular generalized paralysis. The diagnosis is made when there is progressive areflexic weakness (usually starting in the lower extremities), preceded in 50% of patients by back pain or leg paresthesias. Increased protein levels without cells in the cerebrospinal fluid (after the first week), prolonged distal latencies, and F-waves and antiganglioside

Stroke

Pregnancy is a physiologic state. However, it causes remodeling of the heart and all blood vessels. In animal studies, the walls of systemic arteries have shown a reduction in collagen and elastin content as well as a loss of distensibility. These biomechanical changes, along with the hemodynamic variation and changes in the levels of procoagulant factors, coagulation inhibitors, and other mediators of clot formation and lysis, make pregnancy a state of hypercoagulability. The incidence and the

Status epilepticus

Most epileptic women have unchanged seizure frequency during pregnancy. Exacerbation of seizures can occur in 37% of pregnant epileptics.107 Status epilepticus (SE) during pregnancy is rare. In a 1999 review of the English literature, 19 case reports were identified. SE was previously experienced in only 3 of 19 women and occurred in the third trimester in 74% of cases.108 In a large prospective antiepileptic drugs and pregnancy registry (EURAP [European Registry of Antiepileptic Drugs and

Brain death

The criteria of diagnosing brain death during pregnancy do not differ from those for nonpregnant women. However, there are several controversial ethical issues for supporting the mother until or beyond the fetus is viable (24 weeks). Her right for autonomy should be balanced against fetal rights for survival. Her wishes and, if never expressed, those of the next of kin, and particularly those of the biological father of the fetus, should be respected.120

How often this catastrophic event happens

First page preview

First page preview
Click to open first page preview

References (125)

  • S. Ferrero et al.

    Myasthenia gravis: management issues during pregnancy

    Eur J Obstet Gynecol Reprod Biol

    (2005)
  • J. Djelmis et al.

    Myasthenia gravis in pregnancy: report on 69 cases

    Eur J Obstet Gynecol Reprod Biol

    (2002)
  • G.J. Daskalakis et al.

    Myasthenia gravis and pregnancy

    Eur J Obstet Gynecol Reprod Biol

    (2000)
  • G.J. Luijckx et al.

    Guillain-Barre syndrome in mother and newborn child

    Lancet

    (1997)
  • H. Yamada et al.

    Massive intravenous immunoglobulin treatment in pregnancy complicated by Guillain-Barre Syndrome

    Eur J Obstet Gynecol Reprod Biol

    (2001)
  • S. Kocabas et al.

    Anesthetic management of Guillain-Barre syndrome in pregnancy

    J Clin Anesth

    (2007)
  • C. Vaduva et al.

    Severe Guillain-Barre syndrome and pregnancy: two cases with rapid improvement post-partum

    Rev Neurol (Paris)

    (2006)
  • C. Demers et al.

    Deep venous thrombosis and pulmonary embolism in pregnancy

    Clin Chest Med

    (1992)
  • L.A. Barbour

    Current concepts of anticoagulant therapy in pregnancy

    Obstet Gynecol Clin North Am

    (1997)
  • M.A. Stoodley et al.

    Pregnancy and intracranial aneurysms

    Neurosurg Clin North Am

    (1998)
  • M. Piotin et al.

    Endovascular treatment of acutely ruptured intracranial aneurysms in pregnancy

    Am J Obstet Gynecol

    (2001)
  • D.O. Selo-Ojeme et al.

    Aneurysmal subarachnoid haemorrhage in pregnancy

    Eur J Obstet Gynecol Reprod Biol

    (2004)
  • A.J. Ringer et al.

    Angioplasty for cerebral vasospasm from eclampsia

    Surg Neurol

    (2001)
  • J.S. Jeng et al.

    Stroke in women of reproductive age: comparison between stroke related and unrelated to pregnancy

    J Neurol Sci

    (2004)
  • American College of Obstetricians and Gynecologists et al.

    Report of the American College of Obstetricians and Gynecologists' Task Force on Hypertension in Pregnancy

    Obstet Gynecol

    (2013)
  • K.A. Douglas et al.

    Eclampsia in the United Kingdom

    BMJ

    (1994)
  • R.J. Levine et al.

    Circulating angiogenic factors in preeclampsia

    Clin Obstet Gynecol

    (2005)
  • P.W. Kaplan

    Neurologic issues in eclampsia

    Rev Neurol (Paris)

    (1999)
  • M.J. Cipolla

    Cerebrovascular function in pregnancy and eclampsia

    Hypertension

    (2007)
  • J.F. Miles et al.

    Postpartum eclampsia: a recurring perinatal dilemma

    Obstet Gynecol

    (1990)
  • S. Porapakkham

    An epidemiologic study of eclampsia

    Obstet Gynecol

    (1979)
  • I.T. Zak et al.

    Imaging of neurologic disorders associated with pregnancy and the postpartum period

    Radiographics

    (2007)
  • D. Altman et al.

    Do women with pre-eclampsia, and their babies, benefit from magnesium sulphate? The Magpie Trial: a randomised placebo-controlled trial

    Lancet

    (2002)
  • Which anticonvulsant for women with eclampsia? Evidence from the Collaborative Eclampsia Trial

    Lancet

    (1995)
  • M.J. Lucas et al.

    A comparison of magnesium sulfate with phenytoin for the prevention of eclampsia

    N Engl J Med

    (1995)
  • M.A. Belfort et al.

    A comparison of magnesium sulfate and nimodipine for the prevention of eclampsia

    N Engl J Med

    (2003)
  • Committee on Obstetric Practice

    Committee opinion no. 623: emergent therapy for acute-onset, severe hypertension during pregnancy and the postpartum period

    Obstet Gynecol

    (2015)
  • L. Duley et al.

    Drugs for rapid treatment of very high blood pressure during pregnancy

    Cochrane Database Syst Rev

    (2000)
  • P. von Dadelszen et al.

    Evidence-based management for preeclampsia

    Front Biosci

    (2007)
  • S.E. Lapinsky et al.

    Critical care in the pregnant patient

    Am J Respir Crit Care Med

    (1995)
  • L.A. Magee et al.

    Fortnightly review: management of hypertension in pregnancy

    BMJ

    (1999)
  • T.E. Gillon et al.

    Hypertensive disorders of pregnancy: a systematic review of international clinical practice guidelines

    PLoS One

    (2014)
  • J.M. O'Brien et al.

    Controversies with the diagnosis and management of HELLP syndrome

    Clin Obstet Gynecol

    (2005)
  • M.A. Murphy et al.

    Permanent visual deficits secondary to the HELLP syndrome

    J Neuroophthalmol

    (2005)
  • C. Hirashima et al.

    Hydrocephalus after intraventricular hemorrhage in eclamptic woman with HELLP syndrome

    Hypertens Pregnancy

    (2006)
  • Y. Soh et al.

    A case of postpartum cerebellar infarction with hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome

    Gynecol Obstet Invest

    (2002)
  • C. Altamura et al.

    Postpartum cerebellar infarction and haemolysis, elevated liver enzymes, low platelet (HELLP) syndrome

    Neurol Sci

    (2005)
  • J.N. Martin et al.

    Plasma exchange for preeclampsia: III. Immediate peripartal utilization for selected patients with HELLP syndrome

    J Clin Apher

    (1994)
  • P. Matchaba et al.

    Corticosteroids for HELLP syndrome in pregnancy

    Cochrane Database Syst Rev

    (2004)
  • A.P. Batocchi et al.

    Course and treatment of myasthenia gravis during pregnancy

    Neurology

    (1999)
  • Cited by (0)

    Disclosures: The authors have nothing to disclose.

    View full text