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
