Department of Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Eur J Neurol. 2024 Mar;31(3):e16012. doi: 10.1111/ene.16012. Epub 2023 Aug 11.
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.
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.
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.
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.
妊娠或产褥期（pICH）期间发生的脑出血是全球导致产妇死亡的主要原因之一。然而，关于 pICH 的病因和结局的流行病学数据有限，这对于指导预防和治疗至关重要。
本研究在芬兰进行了一项回顾性全国性队列研究和嵌套病例对照研究。我们通过链接医疗出生登记（MBR）和住院记录（HDR）来识别发生 pICH 的女性。临床详细信息从患者记录中收集。从 MBR 中为每个病例选择了 3 个与未发生 ICH 的妊娠相匹配的对照。
共确定了 49 例 pICH 病例。其中一半发生在妊娠期间，另一半发生在围产期和产褥期。根据 SMASH-U（结构性血管病变、药物、淀粉样血管病、系统性疾病、高血压、原因不明）分类，35.4%的患者患有系统性疾病，最常见的是子痫前期、子痫或 HELLP（溶血、肝酶升高、血小板减少）综合征；31.3%的患者存在结构性血管病变；31.3%的患者病因不明；1 例患者（2.1%）患有高血压。最重要的危险因素是妊娠高血压疾病（HDP；优势比=3.83，95%置信区间=1.60-9.15），31%的病例存在 HDP。产妇死亡率为 12.5%，存活妇女中有 20.9%在 pICH 后 3 个月存在严重残疾（改良 Rankin 量表=3-5）。患有系统性疾病的女性预后最差。
即使在一个拥有全面妊娠监测系统的国家，pICH 的产妇死亡率仍然很高，且后果严重。早期识别和治疗关键危险因素 HDP 对于预防这种严重的妊娠并发症至关重要。
