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Etiology of intracerebral hemorrhage during pregnancy or puerperium: A nationwide study.

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Title: Etiology of intracerebral hemorrhage during pregnancy or puerperium: A nationwide study.
Authors: Vest, Teresa (AUTHOR), Rantanen, Kirsi (AUTHOR), Verho, Liisa (AUTHOR), Aarnio, Karoliina (AUTHOR), Korhonen, Aino (AUTHOR), Richardt, Anna (AUTHOR), Strbian, Daniel (AUTHOR), Gissler, Mika (AUTHOR), Laivuori, Hannele (AUTHOR), Tikkanen, Minna (AUTHOR), Ijäs, Petra (AUTHOR)
Source: European Journal of Neurology. Mar2024, Vol. 31 Issue 3, p1-11. 11p.
Subjects: Cerebral hemorrhage, Puerperium, Pregnancy, Pregnancy complications, Peripartum cardiomyopathy, Eclampsia, Etiology of diseases
Geographic Terms: Finland
Abstract: Background and purpose: Intracerebral hemorrhage during pregnancy or puerperium (pICH) is one of the leading causes of maternal death worldwide. However, limited epidemiological data exist on the etiology and outcomes of pICH, which is required to guide prevention and treatment. Methods: A retrospective nationwide cohort study and a nested case–control study was performed in Finland 1987–2016. We identified women with incident pICH by linking the Medical Birth Register (MBR) and the Hospital Discharge Register (HDR). The clinical details were collected from patient records. Three matched controls with a pregnancy without ICH were selected for each case from the MBR. Results: In total, 49 pICH cases were identified. Half of these cases occurred during pregnancy, and the other half during peripartum and puerperium. Based on the SMASH‐U (structural vascular lesion, medication, amyloid angiopathy, systemic disease, hypertension, undetermined) classification, 35.4% of the patients had a systemic disease, most commonly preeclampsia, eclampsia, or HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome; 31.3% had a structural vascular lesion; 31.3% had an undetermined etiology; and one patient (2.1%) had hypertension. The most important risk factor was hypertensive disorders of pregnancy (HDP; odds ratio = 3.83, 95% confidence interval = 1.60–9.15), occurring in 31% of the cases. Maternal mortality was 12.5%, and 20.9% of the surviving women had significant disability (modified Rankin Scale = 3–5) 3 months after the pICH. Women with systemic disease had the worst outcomes. Conclusions: Even in a country with a comprehensive pregnancy surveillance system, the maternal mortality rate for pICH is high, and the sequelae are severe. Early recognition and treatment of the key risk factor, HDP, is crucial to help prevent this serious pregnancy complication. [ABSTRACT FROM AUTHOR]
Copyright of European Journal of Neurology is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Database: Psychology and Behavioral Sciences Collection
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  Data: Etiology of intracerebral hemorrhage during pregnancy or puerperium: A nationwide study.
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  Data: <searchLink fieldCode="AR" term="%22Vest%2C+Teresa%22">Vest, Teresa</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Rantanen%2C+Kirsi%22">Rantanen, Kirsi</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Verho%2C+Liisa%22">Verho, Liisa</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Aarnio%2C+Karoliina%22">Aarnio, Karoliina</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Korhonen%2C+Aino%22">Korhonen, Aino</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Richardt%2C+Anna%22">Richardt, Anna</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Strbian%2C+Daniel%22">Strbian, Daniel</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Gissler%2C+Mika%22">Gissler, Mika</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Laivuori%2C+Hannele%22">Laivuori, Hannele</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Tikkanen%2C+Minna%22">Tikkanen, Minna</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Ijäs%2C+Petra%22">Ijäs, Petra</searchLink> (AUTHOR)
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  Data: <searchLink fieldCode="JN" term="%22European+Journal+of+Neurology%22">European Journal of Neurology</searchLink>. Mar2024, Vol. 31 Issue 3, p1-11. 11p.
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  Data: <searchLink fieldCode="DE" term="%22Cerebral+hemorrhage%22">Cerebral hemorrhage</searchLink><br /><searchLink fieldCode="DE" term="%22Puerperium%22">Puerperium</searchLink><br /><searchLink fieldCode="DE" term="%22Pregnancy%22">Pregnancy</searchLink><br /><searchLink fieldCode="DE" term="%22Pregnancy+complications%22">Pregnancy complications</searchLink><br /><searchLink fieldCode="DE" term="%22Peripartum+cardiomyopathy%22">Peripartum cardiomyopathy</searchLink><br /><searchLink fieldCode="DE" term="%22Eclampsia%22">Eclampsia</searchLink><br /><searchLink fieldCode="DE" term="%22Etiology+of+diseases%22">Etiology of diseases</searchLink>
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  Data: <searchLink fieldCode="DE" term="%22Finland%22">Finland</searchLink>
– Name: Abstract
  Label: Abstract
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  Data: Background and purpose: Intracerebral hemorrhage during pregnancy or puerperium (pICH) is one of the leading causes of maternal death worldwide. However, limited epidemiological data exist on the etiology and outcomes of pICH, which is required to guide prevention and treatment. Methods: A retrospective nationwide cohort study and a nested case–control study was performed in Finland 1987–2016. We identified women with incident pICH by linking the Medical Birth Register (MBR) and the Hospital Discharge Register (HDR). The clinical details were collected from patient records. Three matched controls with a pregnancy without ICH were selected for each case from the MBR. Results: In total, 49 pICH cases were identified. Half of these cases occurred during pregnancy, and the other half during peripartum and puerperium. Based on the SMASH‐U (structural vascular lesion, medication, amyloid angiopathy, systemic disease, hypertension, undetermined) classification, 35.4% of the patients had a systemic disease, most commonly preeclampsia, eclampsia, or HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome; 31.3% had a structural vascular lesion; 31.3% had an undetermined etiology; and one patient (2.1%) had hypertension. The most important risk factor was hypertensive disorders of pregnancy (HDP; odds ratio = 3.83, 95% confidence interval = 1.60–9.15), occurring in 31% of the cases. Maternal mortality was 12.5%, and 20.9% of the surviving women had significant disability (modified Rankin Scale = 3–5) 3 months after the pICH. Women with systemic disease had the worst outcomes. Conclusions: Even in a country with a comprehensive pregnancy surveillance system, the maternal mortality rate for pICH is high, and the sequelae are severe. Early recognition and treatment of the key risk factor, HDP, is crucial to help prevent this serious pregnancy complication. [ABSTRACT FROM AUTHOR]
– Name: AbstractSuppliedCopyright
  Label:
  Group: Ab
  Data: <i>Copyright of European Journal of Neurology is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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      – Type: doi
        Value: 10.1111/ene.16012
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      – Code: eng
        Text: English
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      Pagination:
        PageCount: 11
        StartPage: 1
    Subjects:
      – SubjectFull: Cerebral hemorrhage
        Type: general
      – SubjectFull: Puerperium
        Type: general
      – SubjectFull: Pregnancy
        Type: general
      – SubjectFull: Pregnancy complications
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      – SubjectFull: Peripartum cardiomyopathy
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      – SubjectFull: Eclampsia
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      – SubjectFull: Etiology of diseases
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      – SubjectFull: Finland
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              Text: Mar2024
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