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stroke in pregnant women

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https://www.readbyqxmd.com/read/28157751/inherited-and-uncommon-causes-of-stroke
#1
Jennifer Juhl Majersik
PURPOSE OF REVIEW: This article is a practical guide to identifying uncommon causes of stroke and offers guidance for evaluation and management, even when large controlled trials are lacking in these rarer forms of stroke. RECENT FINDINGS: Fabry disease causes early-onset stroke, particularly of the vertebrobasilar system; enzyme replacement therapy should be considered in affected patients. Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL), often misdiagnosed as multiple sclerosis, causes migraines, early-onset lacunar strokes, and dementia...
February 2017: Continuum: Lifelong Learning in Neurology
https://www.readbyqxmd.com/read/28150433/impaired-maternal-hemodynamics-in-morbidly-obese-women-a-case-control-study
#2
D Vinayagam, J Gutierrez, J Binder, E Mantovani, B Thilaganathan, A Khalil
AIM: Maternal obesity is associated with significant pregnancy complications and is a risk factor for the development of hypertensive disorders of pregnancy as well as other adverse outcomes. There are few data regarding the hemodynamic aberrations observed in maternal obesity. The aim of this study was to investigate maternal hemodynamics in morbidly obese pregnant women. METHODS: This was a prospective, case-control study of morbidly obese women (BMI >40 kg/m(2) ) and controls (BMI 20-29...
February 2, 2017: Ultrasound in Obstetrics & Gynecology
https://www.readbyqxmd.com/read/28121181/resting-heart-rate-trajectories-and-myocardial-infarction-atrial-fibrillation-ischaemic-stroke-and-death-in-the-general-population-the-troms%C3%A3-study
#3
Ekaterina Sharashova, Tom Wilsgaard, Maja-Lisa Løchen, Ellisiv B Mathiesen, Inger Njølstad, Tormod Brenn
Background Resting heart rate is an established risk factor for cardiovascular disease, but long-term individual resting heart rate trajectories and their effect on cardiovascular disease morbidity and mortality have not yet been described. Methods This large population-based longitudinal study included 14,208 men and women aged 20 years or older, not pregnant and not using blood pressure medications, who attended at least two of the three Tromsø Study surveys conducted between 1986-2001. Resting heart rate was measured using an automated Dinamap device...
January 1, 2017: European Journal of Preventive Cardiology
https://www.readbyqxmd.com/read/28069909/pregnancy-increases-stroke-risk-up-to-one-year-postpartum-and-reduces-long-term-risk
#4
Chun-An Cheng, Jiunn-Tay Lee, Hung-Che Lin, Hui-Chen Lin, Chi-Hsiang Chung, Fu-Huang Lin, Chang-Huei Tsao, Yung-Fu Wu, Wu-Chien Chien, Hung-Wen Chiu
BackgroundThe incidence of stroke in pregnant women is low but trending upward. There are few studies of the topic in women of Asian ethnicity.AimWe aim to evaluate stroke risk in Asian women during and after pregnancy.DesignUsing the Taiwan National Health Insurance database (NHIRD), we designed a retrospective study that included 18-45-year-old pregnant women between the years 2000 and 2010. We selected a 1:1 age-matched control group of non-pregnant women. The endpoint was any type of stroke during pregnancy or the postpartum period; otherwise, the patients were tracked until December 31, 2010...
January 9, 2017: QJM: Monthly Journal of the Association of Physicians
https://www.readbyqxmd.com/read/27966404/-ischemic-stroke-in-young-women
#5
M S Ekker, M J H Wermer, N P Riksen, C J M Klijn, F E de Leeuw
- In virtually all age groups, the incidence of ischemic stroke is higher in men. However, in women aged between 25-49 years the prevalence is higher than in men. Female-specific risk factors and disorders may explain this peak.- Pregnancy and the post-partum period are associated with physiological changes which can increase blood coagulation. Complications during pregnancy may also increase the risk of ischaemic stroke.- Migraine with aura and antiphospholipid syndrome are disorders which are also associated with an increased risk of ischaemic stroke...
2016: Nederlands Tijdschrift Voor Geneeskunde
https://www.readbyqxmd.com/read/27913487/venous-thromboembolism-and-stroke-in-pregnancy
#6
Kelley McLean, Mary Cushman
Pregnancy and the postpartum period substantially increase the risk for thrombotic events. Although the absolute risk for thrombosis is low, these events comprise a significant portion of maternal morbidity and mortality. The vast majority of such events are venous, although the risk for ischemic stroke also appears to be increased in pregnancy. This review will explore the overlapping and unique risk factors for venous and arterial thrombosis in pregnancy. Diagnosis and prevention will be discussed, and treatment will be briefly touched on...
December 2, 2016: Hematology—the Education Program of the American Society of Hematology
https://www.readbyqxmd.com/read/27854379/longitudinal-maternal-haemodynamics-in-fetal-growth-restriction-in-pregnancies-at-high-risk-for-placental-insufficiency
#7
Daniel Stott, Papastefanou I, Daniela Paraschiv, Katherine Clark, Nikos A Kametas
OBJECTIVE: Fetal growth restriction is a powerful determinant of poor perinatal outcomes. Our previous work in pregnancies at high risk for the development of hypertension found that early in pregnancy maternal haemodynamics show impaired cardiovascular adaptation in gestations destined to deliver growth-restricted infants. In this study, we serially monitored maternal haemodynamics from the first through to the third trimester in a similar high-risk cohort, in order to determine if, in pregnancies complicated by growth-restriction, these distinct haemodynamic profiles found at presentation persisted throughout pregnancy...
October 31, 2016: Ultrasound in Obstetrics & Gynecology
https://www.readbyqxmd.com/read/27803828/a-historic-case-of-cardiac-surgery-in-pregnancy
#8
Said Benlamkaddem, Adnane Berdai, Smael Labib, Mustapha Harandou
Background. Heart disease is the leading cause of nonobstetric mortality in pregnant women. Because of high risk, medical management represents the first line of treatment. However, when medical treatment fails, cardiac surgery becomes necessary. Case Presentation. A 27-year-old female who underwent successfully cardiac surgery three times within 3 years. At the first time, she had an aortic valve replacement at 25 weeks of gestation after an infectious endocarditis complicated with an ischemic stroke. At 39 weeks of gestation, she had delivered, vaginally, a healthy baby boy weighing 2800 g...
2016: Case Reports in Obstetrics and Gynecology
https://www.readbyqxmd.com/read/27775757/risk-of-pregnancy-associated-stroke-across-age-groups-in-new-york-state
#9
Eliza C Miller, Hajere J Gatollari, Gloria Too, Amelia K Boehme, Lisa Leffert, Mitchell S V Elkind, Joshua Z Willey
Importance: Older age is associated with increased risk of pregnancy-associated stroke (PAS). Data are limited on age-specific incidence ratios of PAS compared with stroke risk in nonpregnant women. Objectives: To assess the risk of stroke by age group in pregnant and postpartum women compared with their nonpregnant contemporaries and to compare risk factors across age groups in the exposed (pregnant/postpartum) and unexposed (nonpregnant) populations. Design, Setting, and Participants: International Classification of Diseases, Ninth Revision, billing codes from the calendar year 2003-2012 New York State Department of Health inpatient database and population data were used to identify all women aged 12 to 55 years with cerebrovascular events, including transient ischemic attack, ischemic and hemorrhagic stroke, cerebral venous thrombosis, and nonspecified PAS...
December 1, 2016: JAMA Neurology
https://www.readbyqxmd.com/read/27762457/longitudinal-hemodynamics-in-acute-phase-of-treatment-with-labetalol-in-hypertensive-pregnant-women-to-predict-need-for-vasodilatory-therapy
#10
D Stott, M Bolten, D Paraschiv, I Papastefanou, J B Chambers, N A Kametas
OBJECTIVE: Hypertensive pregnant women who do not respond to treatment with labetalol to control blood pressure (BP), but require vasodilatory therapy, progress rapidly to severe hypertension. This could be delayed by early recognition and individualized treatment. In this study, we sought to create prediction models from data at presentation and at 1 h and 24 h after commencement of treatment to identify patients who will not have a sustained response to labetalol and therefore need vasodilatory therapy...
January 2017: Ultrasound in Obstetrics & Gynecology
https://www.readbyqxmd.com/read/27733658/postnatal-cardiovascular-consequences-in-the-offspring-of-pregnant-rats-exposed-to-smoking-and-smoking-cessation-pharmacotherapies
#11
Kathirvel Gopalakrishnan, Amar S More, Gary D Hankins, Tatiana N Nanovskaya, Sathish Kumar
Approximately 20% of pregnant women smoke despite intentions to quit. Smoking cessation drugs, such as nicotine replacement therapy (NRT) and bupropion, are recommended treatments. Adverse cardiovascular outcomes in offspring have raised concerns about NRT's safety during pregnancy. However, the effect of bupropion is unknown. Using a rat model, we determined whether NRT and bupropion interventions during pregnancy are safer than continued smoking on offspring's cardiovascular function. Male offspring of controls and dams exposed to cigarette smoke (1...
October 12, 2016: Reproductive Sciences
https://www.readbyqxmd.com/read/27733586/role-of-tumor-necrosis-factor-%C3%AE-and-natural-killer-cells-in-uterine-artery-function-and-pregnancy-outcome-in-the-stroke-prone-spontaneously-hypertensive-rat
#12
Heather Yvonne Small, Ryszard Nosalski, Hannah Morgan, Elisabeth Beattie, Tomasz J Guzik, Delyth Graham, Christian Delles
Women with chronic hypertension are at increased risk of maternal and fetal morbidity and mortality. We have previously characterized the stroke-prone spontaneously hypertensive rat (SHRSP) as a model of deficient uterine artery function and adverse pregnancy outcome compared with the control Wistar-Kyoto. The activation of the immune system plays a role in hypertension and adverse pregnancy outcome. Therefore, we investigated the role of tumor necrosis factor-α in the SHRSP phenotype in an intervention study using etanercept (0...
November 2016: Hypertension
https://www.readbyqxmd.com/read/27680817/h1-persistent-maternal-cardiac-dysfunction-after-preeclampsia-identifies-patients-at-risk-for-recurrent-pre-eclampsia
#13
D Lo Presti, G Gagliardi, G M Tiralongo, I Pisani, B Vasapollo, G P Novelli, H Valensise
OBJECTIVE: The purpose of our study was to assess cardiac function in non-pregnant women with previous early preeclampsia before a second pregnancy to highlight the cardiovascular pattern, which may take a risk for recurrent preeclampsia. METHODS: Seventy-five normotensive patients with previous preeclampsia and 147 controls with a previous uneventful pregnancy were enrolled in a case control study and submitted to echocardiographic examination in the non-pregnant state 12-18 months after the first delivery...
August 2016: Journal of Maternal-fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/27680815/g4-does-maternal-obesity-have-an-adverse-effect-on-haemodynamics
#14
D Vinayagam, Juan Gutierrez, J Binder, B Thilaganathan, A Khalil
BACKGROUND: The increase in the prevalence of and the adverse risks to both mother and foetus associated with maternal obesity is a global concern. The adverse cardiovascular risk associated with obesity is well-known, however, there is a paucity of data assessing central haemodynamics in class 3 (morbid) obesity (BMI440 kg/m(2)) during pregnancy. OBJECTIVE: To compare the haemodynamic profile in women with class 3 maternal obesity against those with a normal BMI (20-30 kg/m(2)), using ultrasound-based, non-invasive haemodynamic monitoring...
August 2016: Journal of Maternal-fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/27628530/gestational-changes-in-left-ventricular-myocardial-contractile-function-new-insights-from-two-dimensional-speckle-tracking-echocardiography
#15
Shantanu P Sengupta, Manish Bansal, Leonard Hofstra, Partho P Sengupta, Jagat Narula
The goal of this study was to evaluate the impact of pregnancy and labor on left ventricular (LV) myocardial mechanics using speckle tracking echocardiography (STE). Pregnancy is characterized by profound hormonal and hemodynamic alterations that directly or indirectly influence cardiac structure and function. However, the impact of these changes on left ventricular (LV) myocardial contractile function has not been fully elucidated. In this prospective, longitudinal study, 35 pregnant women underwent serial clinical and echocardiographic evaluation during each trimester and at labor...
September 14, 2016: International Journal of Cardiovascular Imaging
https://www.readbyqxmd.com/read/27609819/echocardiographic-structure-and-function-in-hypertensive-disorders-of-pregnancy-a-systematic-review
#16
James S Castleman, Ramesh Ganapathy, Fatima Taki, Gregory Y H Lip, Richard P Steeds, Dipak Kotecha
BACKGROUND: Echocardiography is commonly used to direct the management of hypertensive disorders in medical patients, but its application in pregnancy is unclear. Our objective was to define the use of echocardiography in pregnancies complicated by gestational hypertension (GH) and preeclampsia. METHODS AND RESULTS: We performed a systematic review of articles using an electronic search of databases from inception to March 2015, prospectively registered with PROSPERO (CRD42015015700)...
September 2016: Circulation. Cardiovascular Imaging
https://www.readbyqxmd.com/read/27562782/imaging-of-headache-in-pregnancy
#17
REVIEW
Maryna Skliut, Dara G Jamieson
Pregnant women are most likely to have primary headaches, such as migraine and tension-type headaches, which can be diagnosed and treated without brain imaging. Primary headaches may even start de novo during pregnancy, especially in the first few months. However, when the headache occurs late in pregnancy or in the peripartum period, secondary causes of headaches need to be considered and evaluated by brain and/or vascular imaging, generally using magnetic resonance techniques. There is considerable overlap between the cerebrovascular complications of pregnancy, including preeclampsia/eclampsia, posterior reversible encephalopathy syndrome (PRES), reversible cerebral vasoconstriction syndrome (RCVS), and both hemorrhagic and ischemic strokes; although, their imaging may be distinctive...
October 2016: Current Pain and Headache Reports
https://www.readbyqxmd.com/read/27539791/the-long-term-health-effects-of-fetal-malnutrition-evidence-from-the-1959-1961-china-great-leap-forward-famine
#18
Seonghoon Kim, Belton Fleisher, Jessica Ya Sun
We report evidence of long-term adverse health impacts of fetal malnutrition exposure of middle-aged survivors of the 1959-1961 China Famine using data from the China Health and Retirement Longitudinal Study. We find that fetal exposure to malnutrition has large and long-lasting impacts on both physical health and cognitive abilities, including the risks of suffering a stroke, physical disabilities in speech, walking and vision, and measures of mental acuity even half a century after the tragic event. Our findings imply that policies and programs that improve the nutritional status of pregnant women yield benefits on the health of a fetus that extend through the life cycle in the form of reduced physical and mental impairment...
August 19, 2016: Health Economics
https://www.readbyqxmd.com/read/27508763/-op-5d-07-angiogenic-imbalanced-preeclampsia-versus-clinical-preeclampsia
#19
L Saleh, K Verdonk, A Kaya, A H Danser, A H van den Meiracker, W Visser
OBJECTIVE: The ratio of the maternal plasma angiogenic factors soluble Fms-kinase 1 (sFlt-1) and placental growth factor (PlGF) is a novel diagnostic tool for preeclampsia (PE), with a value <38 predicting short-term absence of PE in women in whom the syndrome is suspected clinically. The clinical implication of a single determination below the sFlt-1/PlGF ratio of 38 beyond 1 week remains to be established. We therefore assessed the evolution of the sFlt-1/PlGF ratio in patients suspected of PE on clinical grounds...
September 2016: Journal of Hypertension
https://www.readbyqxmd.com/read/27465979/a-prediction-model-for-the-response-to-oral-labetalol-for-the-treatment-of-antenatal-hypertension
#20
D Stott, M Bolten, M Salman, D Paraschiv, A Douiri, N A Kametas
This prospective observational study aimed to identify at presentation the maternal hemodynamic and demographic variables associated with a therapeutic response to oral labetalol and to use these variables to develop a prediction model to anticipate the response to labetalol monotherapy in women with hypertension. It was set at a maternity unit in a UK teaching hospital. Maternal demographic data from 50 pregnant women, presenting with hypertension between January and August 2013, was collected and blood pressure measured with a device validated for pregnancy and pre-eclampsia...
February 2017: Journal of Human Hypertension
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