Neurological pathologies during pregnancy tied to increased mortality and morbidity: Study
Almost any medical disorder occurring in a woman of childbearing age could complicate the period of pregnancy. There are, however, neurological disorders that are incidental, those that occur more commonly during pregnancy than at other times, or those that worsen or get exacerbated during this period. Some of these diseases are mild not requiring attention but some present with acute neurological emergencies affecting maternal mortality rate. Almost 20% of maternal mortality can be attributed to neurological causes, this alarms neurologists to give the necessary attention to ’red flag signs’. Further, diagnosis and management of these patients cause a hurdle to a neurologist because of the varied adverse effects on the fetus.
Management of pre-existing neurological disorders during epilepsy is also troublesome because of the various hormonal changes. The neurology of pregnancy has been an area of interest and research as related to the care of neurological disorders in pregnancy and the outcome on the maternal and child health. With this in mind, in a retrospective study of three years duration in North East India, authors retrospectively studied all the different neurological disorders occurring during pregnancy and their outcome. All demographic, clinical, and neurological findings, routine investigation, and neurological investigation were recorded. Further analysis was done to find out the most common neurological pathology in pregnancy and classify them into pregnancy-specific, incidental, and preexisting neurological conditions.
A total number of 80 patients were included. The age ranged from 18 to 49 years with the maximum number of patients (forty-four) in the 20-30 age group. Guillain barre syndrome (GBS) seen in 21 patients (26%) which was the most common with maternal mortality and stillbirth. Eclampsia was seen in seventeen patients (21%) with three intra-uterine death and one maternal death noted. The other neurological disease was cerebral venous thrombosis (11%), seizure in isolation (six patients), and seizure with post-partum sepsis (five patients). Myelopathy was seen in four patients, carpal tunnel syndrome and cramps in six patients each, multiple sclerosis, tubercular meningitis (proven), thymoma-negative generalized myasthenia gravis, and arteriovenous malformation in one patient each.
A failure to identify the red flag symptoms associated with various neurological pathologies during pregnancy would lead to a delay in the correct therapeutic approach leading to increased mortality and morbidity. For those with preexisting neurological disease, prior knowledge helps the neurologist to counsel and treatment regime plan to reduce harm to the fetus and avoid relapse in the mother.
Source: Synmon et al. / Indian Journal of Obstetrics and Gynecology Research 2024;11(3):403–408
