Maternal Death Due to Stroke Associated With Pregnancy-Induced Hypertension

Junichi Hasegawa; Tomoaki Ikeda; Akihiko Sekizawa; Hiroaki Tanaka; Masahiko Nakata; Takeshi Murakoshi; Shinji Katsuragi; Kazuhiro Osato; Isamu Ishiwata; Katsuyuki Kinoshita; on behalf of the Maternal Death Exploratory Committee and the Japan Association of Obstetricians and Gynecologists

doi:10.1253/circj.CJ-15-0297

Stroke

Maternal Death Due to Stroke Associated With Pregnancy-Induced Hypertension

Junichi Hasegawa, Tomoaki Ikeda, Akihiko Sekizawa, Hiroaki Tanaka, Masahiko Nakata, Takeshi Murakoshi, Shinji Katsuragi, Kazuhiro Osato, Isamu Ishiwata, Katsuyuki Kinoshita, on behalf of the Maternal Death Exploratory Committee and the Japan Association of Obstetricians and Gynecologists

Author information

Junichi Hasegawa
Department of Obstetrics and Gynecology, Showa University School of Medicine
Tomoaki Ikeda
Department of Obstetrics and Gynecology, Mie University School of Medicine
Akihiko Sekizawa
Department of Obstetrics and Gynecology, Showa University School of Medicine
Hiroaki Tanaka
Department of Obstetrics and Gynecology, Mie University School of Medicine
Masahiko Nakata
Department of Obstetrics and Gynecology, Toho University School of Medicine
Takeshi Murakoshi
Division of Perinatology, Maternal and Perinatal Care Center, Seirei Hamamatsu General Hospital
Shinji Katsuragi
Department of Obstetrics and Gynecology, Sakakibara Heart Institute
Kazuhiro Osato
Department of Obstetrics and Gynecology, Mie University School of Medicine
Isamu Ishiwata
Ishiwata Obstetrics and Gynecology Hospital
Katsuyuki Kinoshita
Seijo-Kinoshita Hospital
on behalf of the Maternal Death Exploratory Committee and the Japan Association of Obstetricians and Gynecologists

Keywords: Hemolysis, elevated liver enzymes and low platelet count (HELLP) syndrome, Intracerebral hemorrhage, Maternal death, Pregnancy-induced hypertension, Stroke

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Supplementary material

2015 Volume 79 Issue 8 Pages 1835-1840

DOI https://doi.org/10.1253/circj.CJ-15-0297

Editorial (79-8 pp. 1695-1696)

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Abstract

Background:The aim of this study was to clarify the clinical features of maternal death due to stroke associated with pregnancy-induced hypertension (PIH) in Japan.Methods and Results:Reported maternal deaths occurring between 2010 and 2012 throughout Japan were analyzed by the Maternal Death Exploratory Committee. Among a total of 154 reports of maternal death, those due to stroke with (n=12) or without (n=13) PIH were compared. Cerebral stroke occurred more frequently in the third trimester and during the second stage of labor in deaths with PIH, whereas it occurred at any time point in deaths not involving PIH. Although 83% of patients with PIH who died had experienced initial symptoms in a hospital, more than half of them required maternal transport due to lack of medical resources. Among the patients without PIH, some vascular abnormalities were identified, but no evidence was found among the patients with PIH. In addition, 58% of PIH cases resulting in stroke were complicated by hemolysis, elevated liver enzymes and low platelet count (HELLP) syndrome.Conclusions:Appropriate management of PIH during pregnancy and labor, including anti-hypertensive therapy and early maternal transport to tertiary hospital, may reduce the maternal death rate. (Circ J 2015; 79: 1835–1840)

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