Vázquez-Rodríguez JG, Ruíz-Huitrón RM

Language: Spanish
References: 20
Page: 172
PDF size: 332.51 Kb.

ABSTRACT

Background: Neurological emergencies during pregnancy and postpartum increase the rate of maternal and fetal morbidity and mortality.
Objective: identify the clinical characteristics, neurological emergencies and perinatal outcomes in pregnant or postpartum patients admitted to the Intensive Care Unit (ICU) of a highly specialized center in Mexico City.
Material and methods: a retrospective, cross-sectional, observational study was carried out in a cohort of 51 patients admitted to the ICU in 2021 and 2022 due to neurological emergencies during pregnancy or in the postpartum stage. Charts were consulted to document clinical characteristics, neurological emergencies, and perinatal outcomes. The data were analyzed using descriptive statistical measures (mean, median, standard deviation, range) with the SPSS™ version 22 statistical program.
Results: maternal age 28.57 ± 7.17 years, gestational age 29.76 ± 6.30 weeks, 64.70% pregnant and 35.30% postpartum. Neurological emergencies were eclampsia 52.94%, epilepsy 31.37%, venous thrombosis of the longitudinal sinus 3.92%, parenchymal hemorrhage 3.92%, posterior reversible encephalopathy 3.92%, eclampsia with cerebral venous thrombosis 1.96% and cerebral edema due to active neurocystercosis 1.96%. The maternal stay in the ICU was 2.87±2.01 days, mortality 0% and organic lesions requiring highly specialized management 23.52%. Fifty newborns were obtained with prematurity 44%, serious complications requiring intensive care 100%, and fetal mortality 14%.
Conclusion: intensive and multidisciplinary management reduced the acute maternal effect of neurological emergencies, but not organic lesions. The fetal morbidity and mortality rate was very high.

REFERENCES

1. Emergencias neurológicas. https://www.neurologocobilt.com › urgencias-neurológicas

2. Edlow JA, Caplan LR, O’Brien K, Tibbles CD. Diagnosis of acuteneurological emergencies in pregnant and post-partum women.Lancet Neurol. 2013;12(2):175-85. DOI: 10.1016/S1474-4422(12)70306-X

3. Gaffney A. Critical care in pregnancy—Is it different? Semin Perinatol.2014;38(6):329-40. DOI: 10.1053/j.semperi.2014.07.002

4. Wunsch H, Angus DC, Harrison DA, Collange O, Fowler R, HosteEAJ, et al. Variation in critical care services across North Americaand Western Europe. Crit Care Med. 2008;36(10):2787-93. DOI:10.1097/CCM.0b013e318186aec8

5. What are some factors that make a pregnancy high risk? https://www.nichd.nih.gov/health/topics/high-risk/conditioninfo/factors

6. Zafarmand S, Javanmardi H, Ameri M, Maneshi M, Mansouri-MehrabadiS, Zolghadrasli Y, et al. Evaluation of the neurologicalcomplaints during pregnancy and postpartum. Galen Med J.2019;8:e1616. DOI: 10.31661/gmj.v8i0.1616

7. Merlino L, Matys V, Crognale A, D’Ovidio G, Della Rocca C, PorporaMG, et al. Neurological complications in pregnancy and thepuerperium: Methodology for a clinical diagnosis. J Clin Med.2023;12:2994. DOI: 10.3390/jcm12082994

8. Bartal MF, Sibai BM. Eclampsia in the 21st century. Am J ObstetGynecol. 2022;226(2S):S1237–S1253. DOI: 10.1016/j.ajog.2020.09.037

9. Elgendy IY, Gad MM, Mahmoud AN, Keeley EC, Pepine CJ. Acutestroke during pregnancy and puerperium. J Am Coll Cardiol.2020;75(2):180–190. DOI: 10.1016/j.jacc.2019.10.056

10. Pilato F, Distefano M, Calandrelli R. Posterior reversible encephalopathysyndrome and reversible cerebral vasoconstriction syndrome:Clinical and radiological considerations. Front Neurol.2020;11:34. DOI: 10.3389/fneur.2020.00034

11. Singhal AB. Posterior reversible encephalopathy syndrome andreversible cerebral vasoconstriction syndrome as syndromesof cerebrovascular dysregulation. Continuum (Minneap Minn).2021;27(5):1301-1320. DOI: 10.1212/CON.0000000000001037

12. Hessler A, Dolbec K. Seizures: summary. Clinical Updates inWomen’s Health Care. American College of Obstetricians andGynecologists. Obstet Gynecol 2021;137:207. DOI: 10.1097/AOG.0000000000004211

13. Nucera B, Brigo F, Trinka E, Kalss G. Treatment and care ofwomen with epilepsy before, during, and after pregnancy: apractical guide. Ther Adv Neurol Disord. 2022;15:1-31. DOI:10.1177/17562864221101687

14. Tomson T, Battino D. Teratogenic effects of antiepileptic drugs. LancetNeurol. 2012;11:803–813. https://www.thelancet.com/journals/laneur/article/PIIS1474-4422(12)70103-5/abstract

15. Bousser MG, Ferro JM. Cerebral venous thrombosis: An update.Lancet Neurol. 2007;6(2):162–170. DOI: 10.1016/S1474-4422(07)70029-7

16. Liang ZW, Gao WL, Feng LM. Clinical characteristics and prognosisof cerebral venous thrombosis in Chinese women during pregnancyand puerperium. Sci Rep. 2017;7:43866. DOI: 10.1038/srep43866

17. Bano S, Farooq MU, Nazir S, Aslam A, Tariq A, Javed MA, etal. Structural imaging characteristic, clinical features and riskfactors of cerebral venous sinus thrombosis: A prospectivecross-sectional analysis from a tertiary care hospital in Pakistan.Diagnostics (Basel). 2021;11(6):958. DOI: 10.3390/diagnostics11060958

18. Pandya ST, Mangalampally K. Critical care in obstetrics. Criticalcare in obstetrics. Indian J Anaesth. 2018;62:724-733. DOI:10.4103/ija.IJA_577_18

19. Pirzada S, Boswell K, Yang J, Asuncion S, Albelo F, Tuchler A,et al. Clinical characteristics and outcomes of obstetric patientstransferred directly to intensive care units. Acute and Critical Care. 2024;39(1):138-145. DOI: 10.4266/acc.2023.01375

20. Camargo EC, Singhal AB. Stroke in pregnancy: A multidisciplinaryapproach. Obstet Gynecol. Clin N Am. 202148:75–96. DOI:10.1016/j.ogc.2020.11.004