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Haemorrhagic stroke in pregnancy


Authors: N. Svobodová 1;  P. Kaščák 1,2;  M. Bojda 3
Authors‘ workplace: Gynekologicko-pôrodnícka klinika, FN Trenčín, Slovenská republika 1;  Fakulta zdravotníctva, TnUAD, Trenčín, Slovenská republika 2;  Neurologické oddelenie, FN Trenčín, Slovenská republika 3
Published in: Ceska Gynekol 2024; 89(2): 108-112
Category: Case Report
doi: https://doi.org/10.48095/cccg2024108

Overview

Objective: To present a case of acute haemorrhagic stroke during 3rd trimester of pregnancy and to describe management and successful delivery of healthy baby. Case report: Haemorrhagic stroke is responsible for significant morbidity and mortality. Prognosis can be improved only by urgent diagnosis and care. We report a case of pregnant woman at 37th week of pregnancy with acute haemorrhagic stroke of unknown etiology with clinical appearance of thunderclap headaches and overall disorientation. We describe diagnostic approach and a successful management followed by further differential diagnosis and treatment. The foetus was delivered by acute caesarean section at 37th week of pregnancy. Conclusion: Occurrence of haemorrhagic stroke in pregnancy is rare. There are no specific guidelines that recommend the time and mode of delivery; therefore, each case is assessed individually.

Keywords:

pregnancy – haemorrhagic stroke – stroke management


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ORCID autora

P. Kaščák 0000-0002-4142-5561

Doručené/Submitted: 18. 10. 2023
Prijaté/Accepted: 20. 11. 2023

MUDr. Natália Svobodová
Gynekologicko-pôrodnícka klinika
FN Trenčín
Legionárska 594/28
911 01 Trenčín
Slovenská republika
natalia.dudejova@gmail.com
Labels
Paediatric gynaecology Gynaecology and obstetrics Reproduction medicine

Article was published in

Czech Gynaecology

Issue 2

2024 Issue 2

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