1
|
Ladhani NNN, Swartz RH, Foley N, Nerenberg K, Smith EE, Gubitz G, Dowlatshahi D, Potts J, Ray JG, Barrett J, Bushnell C, Bal S, Chan WS, Chari R, El Amrani M, Gandhi S, Hill MD, James A, Jeerakathil T, Jin A, Kirton A, Lanthier S, Lausman A, Leffert LR, Mandzia J, Menon B, Pikula A, Poppe A, Saposnik G, Sharma M, Bhogal S, Smitko E, Lindsay MP. Canadian Stroke Best Practice Consensus Statement: Acute Stroke Management during pregnancy. Int J Stroke 2018; 13:743-758. [PMID: 30021491 DOI: 10.1177/1747493018786617] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The Canadian Stroke Best Practice Consensus Statement Acute Stroke Management during Pregnancy is the second of a two-part series devoted to stroke in pregnancy. The first part focused on the unique aspects of secondary stroke prevention in a woman with a prior history of stroke who is, or is planning to become, pregnant. This document focuses on the management of a woman who experiences an acute stroke during pregnancy. This consensus statement was developed in recognition of the need for a specifically tailored approach to the management of this group of patients in the absence of any broad-based, stroke-specific guidelines or consensus statements, which do not exist currently. The foundation for the development of this document was the concept that maternal health is vital for fetal well-being; therefore, management decisions should be based first on the confluence of two clinical considerations: (a) decisions that would be made if the patient wasn't pregnant and (b) decisions that would be made if the patient hadn't had a stroke, then nuanced as needed. While empirical research in this area is limited, this consensus document is based on the best available literature and guided by expert consensus. Issues addressed in this document include initial emergency management, diagnostic imaging, acute stroke treatment, the management of hemorrhagic stroke, anesthetic management, post stroke management for women with a stroke in pregnancy, intrapartum considerations, and postpartum management. These statements are appropriate for healthcare professionals across all disciplines and system planners to ensure pregnant women who experience a stroke have timely access to both expert neurological and obstetric care.
Collapse
Affiliation(s)
- Noor Niyar N Ladhani
- 1 Sunnybrook Health Sciences Centre, Toronto, Canada.,2 Faculty of Medicine (Obstetrics and Gynecology), University of Toronto, Toronto, Canada
| | - Richard H Swartz
- 1 Sunnybrook Health Sciences Centre, Toronto, Canada.,3 Faculty of Medicine (Neurology), University of Toronto, Toronto, Canada
| | - Norine Foley
- 4 Department of Foods and Nutrition, Western University, London, Ontario, Canada.,5 workHORSE Consulting Group, London, Ontario, Canada
| | - Kara Nerenberg
- 6 Department of Medicine, University of Calgary, Calgary, Canada
| | - Eric E Smith
- 7 Department of Clinical Neurosciences, University of Calgary, Calgary, Canada.,8 Calgary Stroke Program, Calgary, Canada
| | - Gord Gubitz
- 9 Queen Elizabeth II Health Sciences Centre, Halifax, Canada.,10 Department of Medicine (Neurology), Dalhousie University, Halifax, Canada
| | | | - Jayson Potts
- 12 Department of Obstetric General Internal Medicine, British Columbia Women's Hospital, Vancouver, Canada
| | - Joel G Ray
- 2 Faculty of Medicine (Obstetrics and Gynecology), University of Toronto, Toronto, Canada.,13 Department of Maternal-Fetal Medicine, St. Michael's Hospital, Toronto, Canada
| | - Jon Barrett
- 1 Sunnybrook Health Sciences Centre, Toronto, Canada.,2 Faculty of Medicine (Obstetrics and Gynecology), University of Toronto, Toronto, Canada
| | - Cheryl Bushnell
- 14 Wake Forest Baptist Stroke Center, Wake Forest Baptist Health, Winston Salem, NC, USA
| | - Simerpreet Bal
- 7 Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
| | - Wee-Shian Chan
- 12 Department of Obstetric General Internal Medicine, British Columbia Women's Hospital, Vancouver, Canada
| | - Radha Chari
- 15 Faculty of Medicine & Dentistry, Department of Obstetrics and Gynecology, University of Alberta, Edmonton, Canada
| | - Meryem El Amrani
- 16 Centre hospitalier de l'Université de Montréal, Montreal, Canada
| | - Shital Gandhi
- 2 Faculty of Medicine (Obstetrics and Gynecology), University of Toronto, Toronto, Canada.,17 Sinai Health System, Toronto, Canada
| | - Michael D Hill
- 7 Department of Clinical Neurosciences, University of Calgary, Calgary, Canada.,8 Calgary Stroke Program, Calgary, Canada
| | - Andra James
- 18 Division of Maternal-Fetal Medicine, Duke University, Durham, NC, USA
| | - Thomas Jeerakathil
- 19 Department of Medicine & Dentistry (Neurosciences), University of Alberta, Edmonton, Canada
| | - Albert Jin
- 20 Department of Medicine, Queen's University, Kingston, Canada
| | - Adam Kirton
- 7 Department of Clinical Neurosciences, University of Calgary, Calgary, Canada.,8 Calgary Stroke Program, Calgary, Canada
| | - Sylvain Lanthier
- 16 Centre hospitalier de l'Université de Montréal, Montreal, Canada
| | - Andrea Lausman
- 2 Faculty of Medicine (Obstetrics and Gynecology), University of Toronto, Toronto, Canada.,13 Department of Maternal-Fetal Medicine, St. Michael's Hospital, Toronto, Canada
| | - Lisa Rae Leffert
- 21 Department of Obstetric Anesthesia, Massachusetts General Hospital, Boston, MA, USA
| | - Jennifer Mandzia
- 22 Department of Clinical Neurological Sciences, Western University, London, Canada
| | - Bijoy Menon
- 7 Department of Clinical Neurosciences, University of Calgary, Calgary, Canada.,8 Calgary Stroke Program, Calgary, Canada
| | - Aleksandra Pikula
- 3 Faculty of Medicine (Neurology), University of Toronto, Toronto, Canada.,23 Neurovascular Unit, University Health Network/Toronto Western Hospital, Toronto, Canada
| | - Alexandre Poppe
- 24 Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Gustavo Saposnik
- 3 Faculty of Medicine (Neurology), University of Toronto, Toronto, Canada.,25 Stroke Research Unit, St. Michael's Hospital, Toronto, Canada
| | - Mukul Sharma
- 26 Division of Neurology, Department of Medicine, McMaster University, Hamilton, Canada
| | - Sanjit Bhogal
- 5 workHORSE Consulting Group, London, Ontario, Canada
| | | | - M Patrice Lindsay
- 27 Heart and Stroke Foundation of Canada, Toronto, Canada.,28 Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| |
Collapse
|
2
|
Swartz RH, Ladhani NNN, Foley N, Nerenberg K, Bal S, Barrett J, Bushnell C, Chan WS, Chari R, Dowlatshahi D, Amrani ME, Gandhi S, Gubitz G, Hill MD, James A, Jeerakathil T, Jin A, Kirton A, Lanthier S, Lausman A, Leffert LR, Mandzia J, Menon B, Pikula A, Poppe A, Potts J, Ray J, Saposnik G, Sharma M, Smith EE, Bhogal S, Smitko E, Lindsay MP. Canadian stroke best practice consensus statement: Secondary stroke prevention during pregnancy. Int J Stroke 2017; 13:406-419. [PMID: 29171360 DOI: 10.1177/1747493017743801] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The Canadian Stroke Best Practice Consensus Statement: Secondary Stroke Prevention during Pregnancy, is the first of a two-part series devoted to stroke in pregnancy. This document focuses on unique aspects of secondary stroke prevention in a woman with a prior history of stroke or transient ischemic attack who is, or is planning to become, pregnant. Although stroke is relatively rare in this cohort, several aspects of pregnancy can increase stroke risk during or immediately after pregnancy. The rationale for the development of this consensus statement is based on the premise that stroke in this group requires a specifically-tailored management approach. No other broad-based, stroke-specific guidelines or consensus statements exist currently. Underpinning the development of this document was the concept that maternal health is vital for fetal wellbeing; therefore, management decisions should be based on the confluence of two clinical considerations: (a) decisions that would be made if the patient was not pregnant and (b) decisions that would be made if the patient had not had a stroke. While empirical research in this area is limited, this consensus document is based on the best available literature and guided by expert consensus. Issues addressed in this document include general management considerations for secondary stroke prevention, the use of antithrombotics, blood pressure management, lipid management, diabetes care, and management for specific ischemic stroke etiologies in pregnancy. The focus is on maternal and fetal health while minimizing risks of a recurrent stroke, through counseling, monitoring, and the safety of select pharmacotherapy. These statements are appropriate for health care professionals across all disciplines.
Collapse
Affiliation(s)
- Richard H Swartz
- 1 Sunnybrook Health Sciences Centre, Toronto, Canada.,2 12366 Faculty of Medicine (Neurology), University of Toronto , Canada
| | - Noor Niyar N Ladhani
- 1 Sunnybrook Health Sciences Centre, Toronto, Canada.,3 12366 Faculty of Medicine (Obstetrics and Gynecology), University of Toronto , Canada
| | - Norine Foley
- 4 Department of Foods and Nutrition, Western University, London, ON, Canada.,5 workHORSE Consulting Group, London, ON, Canada
| | - Kara Nerenberg
- 6 Department of Medicine, 70401 University of Calgary , Canada
| | - Simerpreet Bal
- 7 Department of Clinical Neurosciences, 70401 University of Calgary , Canada
| | - Jon Barrett
- 1 Sunnybrook Health Sciences Centre, Toronto, Canada.,3 12366 Faculty of Medicine (Obstetrics and Gynecology), University of Toronto , Canada
| | - Cheryl Bushnell
- 8 Wake Forest Baptist Stroke Center, Wake Forest Baptist Health, Winston Salem, NC, USA
| | - Wee-Shian Chan
- 9 Department of Obstetric General Internal Medicine, 8163 British Columbia Women's Hospital , Vancouver, Canada
| | - Radha Chari
- 10 Department of Medicine & Dentistry, Obstetrics and Gynecology, 215465 University of Alberta , Canada
| | | | - Meryem El Amrani
- 12 Hôpital du Sacré-Coeur de Montréal, Neurology, Montreal, Canada
| | - Shital Gandhi
- 3 12366 Faculty of Medicine (Obstetrics and Gynecology), University of Toronto , Canada.,13 Sinai Health System, Toronto, Canada
| | - Gord Gubitz
- 14 Queen Elizabeth II Health Sciences Centre, Halifax, Canada.,15 Department of Medicine (Neurology), Dalhousie University, Canada
| | - Michael D Hill
- 7 Department of Clinical Neurosciences, 70401 University of Calgary , Canada.,16 Calgary Stroke Program, Canada
| | - Andra James
- 17 Division of Maternal-Fetal Medicine, Duke University, Durham, NC, USA
| | - Thomas Jeerakathil
- 18 Department of Medicine & Dentistry (Neurosciences), 215465 University of Alberta , Canada
| | - Albert Jin
- 19 Department of Medicine, Queen's University, Canada
| | - Adam Kirton
- 7 Department of Clinical Neurosciences, 70401 University of Calgary , Canada.,16 Calgary Stroke Program, Canada
| | - Sylvain Lanthier
- 12 Hôpital du Sacré-Coeur de Montréal, Neurology, Montreal, Canada
| | - Andrea Lausman
- 3 12366 Faculty of Medicine (Obstetrics and Gynecology), University of Toronto , Canada.,20 Department of Maternal-Fetal Medicine, St. Michael's Hospital, Canada
| | - Lisa Rae Leffert
- 21 Department of Obstetric Anesthesia, 2348 Massachusetts General Hospital , Boston, MA, USA
| | - Jennifer Mandzia
- 22 Department of Clinical Neurological Sciences, Western University, London, ON, Canada
| | - Bijoy Menon
- 7 Department of Clinical Neurosciences, 70401 University of Calgary , Canada.,16 Calgary Stroke Program, Canada
| | - Aleksandra Pikula
- 2 12366 Faculty of Medicine (Neurology), University of Toronto , Canada.,23 Neurovascular Unit, UHN/Toronto Western Hospital, Toronto, ON, Canada
| | - Alexandre Poppe
- 24 Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Jayson Potts
- 9 Department of Obstetric General Internal Medicine, 8163 British Columbia Women's Hospital , Vancouver, Canada
| | - Joel Ray
- 3 12366 Faculty of Medicine (Obstetrics and Gynecology), University of Toronto , Canada.,20 Department of Maternal-Fetal Medicine, St. Michael's Hospital, Canada
| | - Gustavo Saposnik
- 2 12366 Faculty of Medicine (Neurology), University of Toronto , Canada.,25 St. Michael's Hospital Stroke Research Unit, Toronto, ON, Canada
| | - Mukul Sharma
- 26 Department of Medicine, Division of Neurology, McMaster University, Hamilton, ON, Canada
| | - Eric E Smith
- 7 Department of Clinical Neurosciences, 70401 University of Calgary , Canada.,16 Calgary Stroke Program, Canada
| | | | - Elisabeth Smitko
- 27 282184 Heart and Stroke Foundation of Canada , Toronto, ON, Canada
| | - M Patrice Lindsay
- 27 282184 Heart and Stroke Foundation of Canada , Toronto, ON, Canada.,28 Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | | |
Collapse
|