Aslam Javaria, Luqman Shoaib, Arif Umair, Alam Mazhar Faiz, Muzammil Khursheed, Nasreen Saima, Khan Muhammad Danial, Khan Ayesha Ali, Thakur Amit Kumar
Department of Medicine, Nishtar Medical University, Multan, 60600, Pakistan.
Department of Neurology, Bahawal Victoria Hospital, Quaid e Azam Medical College, Bahawalpur, 63100, Pakistan.
Neurol Sci. 2025 Sep 5. doi: 10.1007/s10072-025-08440-z.
There is growing incidence of postpartum stroke globally. We aim to assess the incidence rate, predicting factors and outcome of postpartum stroke in a middle income country. In one year long bidirectional study, patients with acute postpartum stroke developed within six weeks after delivery were cases compared to matched control group without stroke in 1:2 ratio. Gestational age, number of pregnancies, BMI, comorbid conditions, evidence of infection, history of stroke, headache, proteinuria, and anemia at time of presentation were exposure variables. The outcome measures were incidence of postpartum stroke and functional outcome of postpartum stroke within four weeks of its development.
The incidence rate was 112 new strokes per 100,000 deliveries. The mean ages of cases (290) and controls (400) were 29.5±7.4 and 26.6±5.2 respectively. Among postpartum strokes, 54.8% were ischemic, 22.4% hemorrhagic, 20% venous infarcts, and 2.8% RCVS. Compared with control group patient with postpartum stroke were more likely to be overweight (OR 2.6; 95%CI, 1.71-4.14), anemic (OR, 4.4; CI, 2.50, 8.06), grandmultiparous (OR 2.5 ; CI, 1.27, 5.15), smoker (3.4; CI, 1.76, 6.7), had history of previous stroke (3.77; CI, 1.84, 7.72), migraine (OR 15 ; CI, 8.58, 26.26), infection (OR 2.9; CI, 1.81, 4.94) and heavy proteinuria (OR 4.4; CI, 2.5, 8.06),. Among cases 32 (11%) were died while 70.9% of the survivors had no residual weakness. According to the modified Rankin Score, 79% of post-partum stroke patients had good outcomes, while 61 (21%) had poor outcomes, 32 of whom died within 28 days.
The incidence of postpartum stroke is increasing, particularly in low-income countries. Patients with established risk factors for postpartum stroke should get particular attention and all possible measures should be taken to mitigate those risk factors.
全球范围内产后中风的发病率呈上升趋势。我们旨在评估一个中等收入国家产后中风的发病率、预测因素及预后情况。在一项为期一年的双向研究中，将分娩后六周内发生急性产后中风的患者作为病例组，与未患中风的匹配对照组按1:2的比例进行比较。孕龄、妊娠次数、体重指数、合并症、感染证据、中风病史、头痛、蛋白尿及就诊时的贫血情况为暴露变量。结局指标为产后中风的发病率及其发生后四周内的功能预后。
每100,000例分娩中有112例新发中风。病例组（290例）和对照组（400例）的平均年龄分别为29.5±7.4岁和26.6±5.2岁。在产后中风患者中，缺血性中风占54.8%，出血性中风占22.4%，静脉梗死占20%，可逆性脑血管收缩综合征占2.8%。与对照组相比，产后中风患者更易出现超重（比值比[OR] 2.6；95%置信区间[CI]，1.71 - 4.14）、贫血（OR，4.4；CI, 2.50, 8.06）、多产（OR 2.5；CI, 1.27, 5.15）、吸烟（3.4；CI, 1.76, 6.7）、有中风病史（3.77；CI, 1.84, 7.72）、偏头痛（OR 15；CI, 8.58, 26.26）、感染（OR 2.9；CI, 1.81, 4.94）及重度蛋白尿（OR 4.4；CI, 2.5, 8.06）。病例组中有32例（11%）死亡，而70.9%的幸存者无残留肢体无力症状。根据改良Rankin评分，79%的产后中风患者预后良好，61例（21%）预后不良，其中32例在28天内死亡。
产后中风的发病率正在上升，尤其是在低收入国家。具有产后中风既定危险因素的患者应得到特别关注，并应采取一切可能措施减轻这些危险因素。
