Stroke in Pregnancy and Puerperium - Current Knowledge, Questions and Controversies

Stroke associated with pregnancy and the postpartum period (SiPP) is not common but its consequences can be devastating both for the mother and the child. Pregnancy confers a substantially increased risk of stroke, especially during the third trimester and until 6 weeks postpartum. SiPP is heterogeneous both in aetiology and presentation as it includes both ischemic and haemorrhagic events as well as cerebral venous thrombosis. Specific risk factors for SiPP have been identified and well described, such as hypertensive disorders of pregnancy and a prothrombotic state. However, it is still a controversial issue if pregnancy should be considered a risk factor for stroke, although pregnancy and postpartum period clearly increase the stroke risk compared to non-pregnant time. Recent European Stroke Organization [ESO] guidelines addressed the management of acute SiPP while other issues, particularly primary and secondary prevention are still under investigated. There is also a lack of research and knowledge regarding long-term mother and foetus/child outcomes post-SiPP. This paper addresses current knowledge on SiPP management and prognosis and discusses new challenging clinical scenarios including the relationship between COVID-19 infection and SiPP.