Factors contributing to mortality and morbidity in pregnancy-associated intracerebral hemorrhage in Japan

Jun Yoshimatsu, Tomoaki Ikeda, Shinji Katsuragi, Kazuo Minematsu, Kazunori Toyoda, Kazuyuki Nagatsuka, Hiroaki Naritomi, Susumu Miyamoto, Koji Iihara, Haruko Yamamoto, Yasumasa Ohno

Research output: Contribution to journalArticle

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Abstract

Aim: The aim of this study was to analyze the causes and outcomes for intracerebral hemorrhage (ICH) occurring during pregnancy and postnatally. Material and Methods: A nationwide study of pregnancy-related ICH in Japan was performed. We contacted 1582 facilities to identify women with ICH in pregnancy or postnatally between 1 January 2006 and 31 December 2006.A total of 1012 facilities (70%) responded with completed questionnaires. Risk factors for ICH, neurological features, onset to diagnosis time (O-D time), and obstetric data were recorded. Results: Thirty-eight cases of pregnancy-associated ICH were identified, corresponding to 3.5 per 100 000 deliveries. There were seven maternal deaths, giving a case mortality rate of 18.4%. Pre-eclampsia was identified in 10 cases (26.3%) and hemolysis elevated liver enzymes and low platelet count (HELLP) syndrome was present in five. There were four cases (10.5%) with Moyamoya disease and seven (18.4%) with arteriovenous malformation. HELLP syndrome and moderately or severely disturbed consciousness at disease onset were significantly associated with a poor outcome (modified Rankin Scale ≥3). Pre-eclampsia, HELLP syndrome and O-D time >3 h were significantly associated with maternal mortality. Conclusion: Early diagnosis may prevent maternal death, even in severe cases of pregnancy-related ICH. However, maternal-fetal care centers do not always have full-time neurosurgeons or diagnostic imaging tools suitable for diagnosis of ICH. Thus, a network should be established between maternity centers and neurosurgery departments with computed tomography or magnetic resonance imaging available at all times. We recommend transferal of pregnant women with neurological symptoms to a regional facility that is equipped to treat such patients.

Original languageEnglish
Pages (from-to)1267-1273
Number of pages7
JournalJournal of Obstetrics and Gynaecology Research
Volume40
Issue number5
DOIs
Publication statusPublished - Jan 1 2014
Externally publishedYes

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Cerebral Hemorrhage
Japan
Morbidity
Pregnancy
Mortality
Hemolysis
Platelet Count
Maternal Death
Pre-Eclampsia
Liver
Enzymes
Moyamoya Disease
Maternal Mortality
Arteriovenous Malformations
Neurosurgery
Diagnostic Imaging
Consciousness
Obstetrics
Pregnant Women
Early Diagnosis

All Science Journal Classification (ASJC) codes

  • Obstetrics and Gynaecology

Cite this

Yoshimatsu, J., Ikeda, T., Katsuragi, S., Minematsu, K., Toyoda, K., Nagatsuka, K., ... Ohno, Y. (2014). Factors contributing to mortality and morbidity in pregnancy-associated intracerebral hemorrhage in Japan. Journal of Obstetrics and Gynaecology Research, 40(5), 1267-1273. https://doi.org/10.1111/jog.12336

Factors contributing to mortality and morbidity in pregnancy-associated intracerebral hemorrhage in Japan. / Yoshimatsu, Jun; Ikeda, Tomoaki; Katsuragi, Shinji; Minematsu, Kazuo; Toyoda, Kazunori; Nagatsuka, Kazuyuki; Naritomi, Hiroaki; Miyamoto, Susumu; Iihara, Koji; Yamamoto, Haruko; Ohno, Yasumasa.

In: Journal of Obstetrics and Gynaecology Research, Vol. 40, No. 5, 01.01.2014, p. 1267-1273.

Research output: Contribution to journalArticle

Yoshimatsu, J, Ikeda, T, Katsuragi, S, Minematsu, K, Toyoda, K, Nagatsuka, K, Naritomi, H, Miyamoto, S, Iihara, K, Yamamoto, H & Ohno, Y 2014, 'Factors contributing to mortality and morbidity in pregnancy-associated intracerebral hemorrhage in Japan', Journal of Obstetrics and Gynaecology Research, vol. 40, no. 5, pp. 1267-1273. https://doi.org/10.1111/jog.12336
Yoshimatsu, Jun ; Ikeda, Tomoaki ; Katsuragi, Shinji ; Minematsu, Kazuo ; Toyoda, Kazunori ; Nagatsuka, Kazuyuki ; Naritomi, Hiroaki ; Miyamoto, Susumu ; Iihara, Koji ; Yamamoto, Haruko ; Ohno, Yasumasa. / Factors contributing to mortality and morbidity in pregnancy-associated intracerebral hemorrhage in Japan. In: Journal of Obstetrics and Gynaecology Research. 2014 ; Vol. 40, No. 5. pp. 1267-1273.
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abstract = "Aim: The aim of this study was to analyze the causes and outcomes for intracerebral hemorrhage (ICH) occurring during pregnancy and postnatally. Material and Methods: A nationwide study of pregnancy-related ICH in Japan was performed. We contacted 1582 facilities to identify women with ICH in pregnancy or postnatally between 1 January 2006 and 31 December 2006.A total of 1012 facilities (70{\%}) responded with completed questionnaires. Risk factors for ICH, neurological features, onset to diagnosis time (O-D time), and obstetric data were recorded. Results: Thirty-eight cases of pregnancy-associated ICH were identified, corresponding to 3.5 per 100 000 deliveries. There were seven maternal deaths, giving a case mortality rate of 18.4{\%}. Pre-eclampsia was identified in 10 cases (26.3{\%}) and hemolysis elevated liver enzymes and low platelet count (HELLP) syndrome was present in five. There were four cases (10.5{\%}) with Moyamoya disease and seven (18.4{\%}) with arteriovenous malformation. HELLP syndrome and moderately or severely disturbed consciousness at disease onset were significantly associated with a poor outcome (modified Rankin Scale ≥3). Pre-eclampsia, HELLP syndrome and O-D time >3 h were significantly associated with maternal mortality. Conclusion: Early diagnosis may prevent maternal death, even in severe cases of pregnancy-related ICH. However, maternal-fetal care centers do not always have full-time neurosurgeons or diagnostic imaging tools suitable for diagnosis of ICH. Thus, a network should be established between maternity centers and neurosurgery departments with computed tomography or magnetic resonance imaging available at all times. We recommend transferal of pregnant women with neurological symptoms to a regional facility that is equipped to treat such patients.",
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AU - Nagatsuka, Kazuyuki

AU - Naritomi, Hiroaki

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AB - Aim: The aim of this study was to analyze the causes and outcomes for intracerebral hemorrhage (ICH) occurring during pregnancy and postnatally. Material and Methods: A nationwide study of pregnancy-related ICH in Japan was performed. We contacted 1582 facilities to identify women with ICH in pregnancy or postnatally between 1 January 2006 and 31 December 2006.A total of 1012 facilities (70%) responded with completed questionnaires. Risk factors for ICH, neurological features, onset to diagnosis time (O-D time), and obstetric data were recorded. Results: Thirty-eight cases of pregnancy-associated ICH were identified, corresponding to 3.5 per 100 000 deliveries. There were seven maternal deaths, giving a case mortality rate of 18.4%. Pre-eclampsia was identified in 10 cases (26.3%) and hemolysis elevated liver enzymes and low platelet count (HELLP) syndrome was present in five. There were four cases (10.5%) with Moyamoya disease and seven (18.4%) with arteriovenous malformation. HELLP syndrome and moderately or severely disturbed consciousness at disease onset were significantly associated with a poor outcome (modified Rankin Scale ≥3). Pre-eclampsia, HELLP syndrome and O-D time >3 h were significantly associated with maternal mortality. Conclusion: Early diagnosis may prevent maternal death, even in severe cases of pregnancy-related ICH. However, maternal-fetal care centers do not always have full-time neurosurgeons or diagnostic imaging tools suitable for diagnosis of ICH. Thus, a network should be established between maternity centers and neurosurgery departments with computed tomography or magnetic resonance imaging available at all times. We recommend transferal of pregnant women with neurological symptoms to a regional facility that is equipped to treat such patients.

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