Abstract
Objective
In the United Kingdom (UK), the maternal mortality rate from stroke is reported at
0.3/100,000 deliveries, but only antenatal data have previously been reviewed. We
hypothesise that the true rate is much higher due to a propensity for stroke occurring
in the post-partum period, and that the rate will rise in parallel with trends of
increasing maternal age and medical co-morbidities. Our objectives are to investigate
the UK stroke mortality rate in pregnancy and the puerperium, and to examine temporal
changes in fatal maternal strokes over a 30 year period.
Study design
Retrospective review of stroke-related maternal deaths reported to the UK confidential
enquiries into maternal death between 1979 and 2008, encompassing 21,514,457 maternities.
In accordance with the ICD.10 classification, cases were divided into direct or indirect
deaths. Late and coincidental deaths were not included in analyses. Lessons from sub-standard
care associated with maternal death from stroke were collated.
Results
In 1979–2008 there were 347 maternal deaths from stroke: 139 cases were direct deaths,
i.e. the fatal stroke was a direct result of pregnancy. The incidence of fatal stroke
is relatively constant at 1.61/100,000 maternities, with a 13.9% (95% CI 12.6–15.3)
proportional mortality rate. Intracranial haemorrhage was the single greatest cause
of maternal death from stroke.
Conclusion
This is the largest UK study examining the incidence of fatal maternal stroke in pregnancy
and the puerperium. Our results highlight the high proportion of women who die from
stroke in the puerperium. Sub-standard care featured especially in regard to management
of dangerously high systolic blood pressure levels. These deaths highlight the importance
of education in managing rapid-onset hypertension and superimposed coagulopathies.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to European Journal of Obstetrics and Gynecology and Reproductive BiologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Saving Mothers’ Lives: reviewing maternal deaths to make motherhood safer: 2006–08. The Eighth Report on Confidential Enquiries into Maternal Deaths in the United Kingdom.BJOG. 2011; 118: 1-203
- Incidence and etiologies of stroke during pregnancy and puerperium as evidenced in Taiwanese women.Cerebrovasc Dis. 2004; 18: 290-295
- Incidence of stroke and myocardial infarction in women of reproductive age.Stroke. 1997; 28: 280-283
- Sex differences in presentation, severity, and management of stroke in a population-based study.Neurology. 2010; 75 ([author reply 1]): 670-671
- Risk factors for peripartum and postpartum stroke and intracranial venous thrombosis.Stroke. 2000; 31: 1274-1282
- Pregnancy and stroke.CNS Spectrosc. 2005; 10: 580-587
- Incidence and risk factors for stroke in pregnancy and the puerperium.Obstet Gynecol. 2005; 106: 509-516
- Stroke and pregnancy.Stroke. 2000; 31: 2948-2951
- Intracerebral hemorrhage in pregnancy: frequency, risk factors, and outcome.Neurology. 2006; 67: 424-429
- Incidence, risk factors, management, and outcomes of stroke in pregnancy.Obstet Gynecol. 2012; 120: 318-324
- Pregnancy and the risk of stroke.N Engl J Med. 1996; 335: 768-774
- Report on Confidential Enquiries into Maternal Deaths in England and Wales 1979–1981.Ministry of Health Report 29, HMSO, London1986
- Report on Confidential Enquiries into Maternal Deaths in England and Wales 1982–1984.Ministry of Health, HMSO, London1989
- Report on Confidential Enquiries into Maternal Deaths in the United Kingdom, 1985–87.HMSO, London1991
- Report on Confidential Enquiries into Maternal Deaths in the United Kingdom 1988–1990.HMSO, London1994
- Report on Confidential Enquiries into Maternal Deaths in the United Kingdom 1991–1993.HMSO, London1996
- Why Mothers Die. Report on Confidential Enquiries into Maternal Deaths in the United Kingdom 1994–1996.HMSO, 1998
- The Confidential Enquiries into Maternal Deaths in the United Kingdom.RCOG Press, London2001
- Lewis G. Saving Mothers’ Lives: Reviewing Maternal Deaths to Make Motherhood Safer – 2003–2005. The Seventh Report on Confidential Enquiries into Maternal Deaths in the United Kingdom. CEMACH, London2007
- Lewis G. Why mothers die 2000–2002. The Sixth Report of the Confidential Enquiries into Maternal Deaths in the United Kingdom. CEMACH, London2004
- Beyond the numbers: reviewing maternal deaths and complications to make pregnancy safer.Br Med Bull. 2003; 67: 27-37
- Stroke Statistics.British Heart Foundation, 2009
- Birth Statistics: Characteristics of Mother 2, England and Wales.2011
- Reports on confidential enquiries into maternal deaths: an audit of previous recommendations.Health Trends. 1995; 26: 26-28
- Which anticonvulsant for women with eclampsia? Evidence from the Collaborative Eclampsia Trial.Lancet. 1995; 345: 1455-1463
- Management of Eclampsia. Guideline no.10.RCOG Press, London1996
- The Management of Hypertensive Disorders in Pregnancy. NICE Guidelines, CG107.2010
- Parity and risk of death from subarachnoid hemorrhage in women: evidence from a cohort in Taiwan.Neurology. 2006; 67: 514-515
Article info
Publication history
Published online: October 07, 2013
Accepted:
September 18,
2013
Received in revised form:
September 9,
2013
Received:
March 23,
2013
Identification
Copyright
© 2013 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
