Aspirin and pre-eclampsia: the heart of the matter?
Aspirin and pre-eclampsia: the heart of the matter? BJOG. 2020 Mar 30;: Authors: Hofmeyr GJ, Magee LA Abstract Ling and colleagues (BJOG 2020 xxxx) have contributed important information on cardiovascular (CV) assessment over the course of pregnancy, with and without aspirin treatment, associated with risk of pre-term pre-eclampsia, as assessed by the multivariable competing risks model at 11-13 weeks. There are a number of important messages in these data. First, women at low- (vs. high-) risk of preterm pre-eclampsia appear to have lower cardiac output (CO), stroke volume (SV), and blood pressure (BP) in early pregnancy, consistent with the hypothesis that maternal CV predisposition plays a major role in pre-eclampsia risk (Ridder A et al. Int J Mol Sci. 2019;20(13)). PMID: 32232916 [PubMed - as supplied by publisher]
This article reviews sex differences in stroke risk and presentation, with a particular emphasis on the unique risk factors women experience throughout the lifespan. RECENT FINDINGS Although prior studies suggested women have worse outcomes after stroke, it is now clear that age, prestroke functional status, and comorbidities explain many of the differences between men and women in stroke severity, functional outcomes, and mortality. Several meta-analyses and large cohort studies have evaluated the risk factors for women related to reproductive factors and found that fewer years between menarche and menopause, pregnancy...
We report a case of PRES with stroke in an adult with intrauterine fetal death (IUFD). Patient concerns: A 35-year-old Asian woman with twin pregnancy underwent cesarean section at 32 weeks of gestation because of IUFD. She presented with focal seizures and visual field defect 2 days after undergoing cesarean section. Her blood pressure and kidney, liver, and coagulation functions were normal without proteinuria. Diagnosis: PRES was diagnosed based on a series of brain magnetic resonance imaging findings. Ischemic infarction in the right frontal lobe eventually developed to encephalomalacia. Interventions: The pat...
CONCLUSIONS: The authors present neurological and obstetric outcomes data in a large cohort of MMD patients. These data indicate that post-bypass pregnancy is accompanied by low complication rates. There were no ischemic or hemorrhagic strokes among post-bypass pregnant MMD patients. The rate of obstetric complications was low overall. The authors recommend close collaboration between the vascular neurosurgeon and the obstetrician regarding medical management, including blood pressure goals and continuation of low-dose aspirin. PMID: 31731267 [PubMed - as supplied by publisher]
Pre-eclampsia was tied to a higher risk of stroke, heart attacks and other problems in mothers.
ConclusionMigraines have a high incidence in gynaecology and obstetrics. Health care providers must include screening questions when history taking to identify women with migraines and effectively manage them. Proper follow-up and treatment is required for all women with migraines in order to minimize the risk of cerebrovascular events, and negative pregnancy outcomes. Women with migraines are advised to avoid combined hormonal contraception and use progesterone only pills.
CONCLUSION: Stroke is the major cause of maternal mortality associated with preeclampsia or eclampsia. All but one patient in this series of strokes demonstrated severe elevation of systolic blood pressure, whereas other variables were less consistently observed. Antihypertensive treatment was not implemented in the majority of cases. Opportunities for care improvement exist and may significantly affect maternal mortality. PMID: 31135728 [PubMed - in process]
Women who experience hypertensive disorders of pregnancy have an increased risk of developing cardiovascular diseases including hypertension, stroke, and ischaemic heart disease later in life.1 –3 This risk is evident shortly after an affected pregnancy and persists for decades.4 The mechanism underlying this association is not known, particularly whether women who develop hypertensive disorders are at higher risk pre-pregnancy and pregnancy unmasks their cardiovascular risk, or whether hypertensive disorders of pregnancy are an index event causing cardiovascular damage.
Hypertensive disorders of pregnancy (HDP) complicate approximately 5 –10% of pregnancies. In the past 20 years, the incidence of HDPs has increased by 25%.1 These disorders, combined with delayed or inadequate treatment of severe systolic hypertension, continue to be leading causes of maternal death; nearly one woman dies every day in the United States of America (USA) and there are an additional 50–60 000 deaths per year worldwide.2,3 A vast majority of deaths result from hemorrhagic stroke and the complications of seizures.
ConclusionsThe large variation in eclampsia and maternal and neonatal fatality from hypertensive disorders of pregnancy between countries emphasises that inequality and inequity persist in healthcare for women with hypertensive disorders of pregnancy. Alongside the growing interest in improving community detection and health education for these disorders, efforts to improve quality of care within healthcare facilities are key. Strategies to prevent eclampsia should be informed by local data. Trial registrationISRCTN: 41244132.
DiscussionCurrent practice in the UK at the time of trial commencement for management of pre-eclampsia varies by gestation. Previous trials have shown that in women with pre-eclampsia after 37 weeks of gestion, delivery is initiated, as maternal complications are reduced without increasing fetal risks. Prior to 34 weeks of gestation, usual management aims to prolong pregnancy for fetal benefit, unless severe complications occur, necessitating preterm delivery. This trial aims to addr ess the uncertainty for women where the balance of benefits and risks of delivery compared to expectant management are uncerta...