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Stroke in Pregnancy. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2023. [DOI: 10.1007/s13669-023-00351-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
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Antoniazzi AM, Unda SR, Khatri D, Holland R, de la Garza Ramos R, Haranhalli N, Altschul DJ. Arterial Ischemic Stroke in Moyamoya patients that underwent Vaginal Delivery and Cesarean. World Neurosurg 2022; 163:e391-e395. [DOI: 10.1016/j.wneu.2022.03.135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 03/27/2022] [Accepted: 03/30/2022] [Indexed: 10/18/2022]
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3
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Morton A. Pregnancy complicated by neurological and neurosurgical conditions - The evidence regarding mode of delivery. Obstet Med 2022; 15:11-18. [PMID: 35444727 PMCID: PMC9014549 DOI: 10.1177/1753495x211000176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 09/21/2020] [Accepted: 02/10/2021] [Indexed: 11/15/2022] Open
Abstract
Neurological and neurosurgical conditions complicating pregnancy may precipitate considerable concern regarding the risk of complications, and uncertainty regarding the preferred mode of delivery and anaesthesia. Caesarean section is known to be associated with significantly increased risk of adverse maternal outcomes compared with vaginal delivery in healthy pregnancy. Nevertheless, a common perception exists among the general population and some health professionals that caesarean section is safer for the mother and baby in high-risk pregnancies. This manuscript examines the literature regarding the risks and outcomes related to mode of delivery in pregnancy complicated by disorders of the central nervous system. With the exception of women with raised intracranial pressure, and some women with Von Hippel-Lindau syndrome, the available evidence suggests that the mode of delivery should be based upon obstetric indications.
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Affiliation(s)
- Adam Morton
- Obstetric Medicine Department, Mater Hospital, South Brisbane,
Australia
- Faculty of Medicine, University of Queensland, St Lucia,
Australia
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Larsson C, Matsson A, Mooe T, Söderström L, Tunón K, Nordin P. Cardiovascular complications following cesarean section and vaginal delivery: a national population-based study. J Matern Fetal Neonatal Med 2021; 35:8072-8079. [PMID: 34275412 DOI: 10.1080/14767058.2021.1941851] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Rates of cesarean section are rising in both developed and developing countries and while pregnancy and cesarean section are established as risk factors for thromboembolism and stroke, large population-based investigations focusing on all types of cardiovascular complication after delivery is missing. The aim was to analyze the risk of severe cardiovascular complications in the post-partum period following delivery by cesarean section. We also had a control group of vaginal deliveries and a reference group with nulliparas. MATERIALS AND METHODS This Swedish population-based study used three national registers between 2005 and 2017 and comprised a total of 1 165 684 individuals. Unselected register data was cross-linked and cardiovascular adverse events were identified by ICD diagnosis codes. 140 128 women (209 391 deliveries) were included in the cesarean group and 614 355 women (973 429 deliveries) in the vaginal control group. The reference group comprised 411 201 age-matched nulliparous women. The primary analysis was the risk of severe cardiovascular complications within 42 days of cesarean section or vaginal delivery. The secondary analysis evaluated risk factors for cardiovascular complications. RESULTS In the cesarean section group, 410 (0.20%) had a serious cardiovascular event within 42 days after delivery, and in the vaginal control group the number was 857 (0.09%). The risk of having an adverse cardiovascular event was significantly greater in the cesarean group (OR 2.23, CI 1.98 to 2.51) for all types of cardiovascular events. Risk factors were high BMI, preeclampsia, greater maternal age, tobacco use and acute cesarean delivery. CONCLUSIONS The absolute numbers on severe maternal morbidity after delivery are low. However, since almost half of the world's population are affected and the frequency of elective cesarean section continues to rise, a doubling of the risk for a severe cardiovascular event within 42 days of delivery is important to consider globally.
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Affiliation(s)
- Charlotta Larsson
- Department of Surgery and Perioperative Science, Surgery, University of Umeå and Östersund Hospital, Östersund, Sweden
| | | | - Thomas Mooe
- Department of Public Health and Clinical Medicine, Östersund, Umeå University, Umeå, Sweden
| | - Lars Söderström
- Department of Research and Development, Hospital of Östersund, Östersund, Sweden
| | - Katarina Tunón
- Department of Clinical Science, Obstetrics and Gynaecology, Umeå University, Umeå, Sweden
| | - Pär Nordin
- Department of Surgery and Perioperative Science, Surgery, University of Umeå and Östersund Hospital, Östersund, Sweden
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Abstract
Pregnancy confers a substantially increased risk of stroke, especially during the third trimester and until 6 weeks postpartum. Hypertensive disorders of pregnancy and gestational hypercoagulability are important contributors to obstetric stroke. Preeclampsia and eclampsia confer risk for future cardiovascular disease. Hemorrhagic stroke is the most common type of obstetric stroke. Ischemic stroke can result from cardiomyopathy, paradoxical embolism, posterior reversible encephalopathy, reversible cerebral vasoconstriction syndrome, and dissections. Cerebral venous sinus thrombosis is a frequent complication of pregnancy.
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Affiliation(s)
- Erica C Camargo
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, WACC 729-C, Boston, MA 02114, USA
| | - Aneesh B Singhal
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, WACC 729-C, Boston, MA 02114, USA.
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Lee HL, Lu KC, Foo J, Huang IT, Fan YC, Tsai PS, Huang CJ. Different impacts of various tocolytic agents on increased risk of postoperative hemorrhage in preterm labor women undergoing Cesarean delivery: A population-based cohort study. Medicine (Baltimore) 2020; 99:e23651. [PMID: 33327348 PMCID: PMC7738150 DOI: 10.1097/md.0000000000023651] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Tocolytic agents, commonly used for inhibiting preterm labor, pose the risk of uterine atony, leading to postpartum hemorrhage. This study elucidated the effects of different tocolytic agents on postoperative hemorrhage among women in preterm labor undergoing Cesarean delivery (CD). Data from Taiwan National Health Insurance Research Database were analyzed. The risk (adjusted hazard ratio [aHR] and 95% confidence intervals [CI]) of postoperative hemorrhage in CD women with preterm labor diagnosis using tocolytic agents (Tocolysis group) comparing to CD women not using tocolytic agents (Control group) were determined. Impacts of different tocolytic agents in this regard were also investigated. Our data revealed that the incidence (11.7% vs 2.6%, P < .001) and risk (aHR: 1.21, 95% CI: 1.12-1.31, P < .001) of postoperative hemorrhage were significantly higher in the Tocolysis group (n = 15,317) than in the Control group (n = 244,096). Ritodrine was the most frequently used tocolytic agent (80.5%), followed by combination therapy (using more than one tocolytic agents) (8.5%), magnesium sulfate (MgSO4, 4.6%), calcium channel blockers (3.8%), betamimetics other than ritodrine (1.9%), prostaglandin synthase inhibitors (0.5%), and nitrates (0.1%). Barring those using calcium channel blockers and combination therapy, the use of MgSO4 (aHR: 1.43, P = .001), betamimetics other than ritodrine (aHR: 1.71, P < .001), prostaglandin synthase inhibitors (aHR: 2.67, P < .001) and nitrates (aHR: 3.30, P = .001) was associated with higher risks of postoperative hemorrhage compared with ritodrine. In conclusion, CD women with preterm labor diagnosis using tocolytic agents exhibit an increased risk of postoperative hemorrhage and that this risk varies with the use of different tocolytic agents.
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Affiliation(s)
| | - Kuo-Ching Lu
- Department of Anesthesiology
- Integrative Research Centre for Critical Care, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Jossen Foo
- Department of Anesthesiology
- Integrative Research Centre for Critical Care, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - I-Tao Huang
- Department of Emergency Medicine, Redcliffe Hospital, Metro North Hospital and Health Service, Queensland Government, Redcliffe
- School of Public Health, Faculty of Medicine, University of Queensland, Herston, QLD, Australia
| | - Yen-Chun Fan
- Department of Anesthesiology
- Integrative Research Centre for Critical Care, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Pei-Shan Tsai
- School of Nursing, College of Nursing
- Department of Nursing
- Research Centre of Big Data and Meta-analysis, Wan Fang Hospital
| | - Chun-Jen Huang
- Department of Anesthesiology
- Integrative Research Centre for Critical Care, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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Roeder HJ, Lopez JR, Miller EC. Ischemic stroke and cerebral venous sinus thrombosis in pregnancy. HANDBOOK OF CLINICAL NEUROLOGY 2020; 172:3-31. [PMID: 32768092 PMCID: PMC7528571 DOI: 10.1016/b978-0-444-64240-0.00001-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Maternal ischemic stroke and cerebral venous sinus thrombosis (CVST) are dreaded complications of pregnancy and major contributors to maternal disability and mortality. This chapter summarizes the incidence and risk factors for maternal arterial ischemic stroke (AIS) and CVST and discusses the pathophysiology of maternal AIS and CVST. The diagnosis, treatment, and secondary preventive strategies for maternal stroke are also reviewed. Special populations at high risk of maternal stroke, including women with moyamoya disease, sickle cell disease, HIV, thrombophilia, and genetic cerebrovascular disorders, are highlighted.
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Affiliation(s)
- Hannah J Roeder
- Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States
| | - Jean Rodriguez Lopez
- Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States
| | - Eliza C Miller
- Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States; NewYork-Presbyterian Hospital, Columbia University Irving Medical Center, New York, NY, United States.
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Abstract
Pregnancy confers a substantially increased risk of stroke in women. The period of highest risk of stroke is the peripartum/postpartum phase, coinciding with the highest risk for hypertensive disorders of pregnancy and peak gestational hypercoagulability. Hemorrhagic stroke is the most common type of obstetric stroke. Hypertensive disorders of pregnancy are important contributors to obstetric stroke and predispose women to premature cardiovascular disease. The rate of stroke associated with hypertensive disorders of pregnancy has increased in the United States. Other conditions associated with obstetric stroke include posterior reversible encephalopathy, reversible cerebral vasoconstriction syndrome, and cerebral venous sinus thrombosis.
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Affiliation(s)
- Erica C Camargo
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
| | - Steven K Feske
- Stroke Division, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Aneesh B Singhal
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, WACC 729-C, Boston, MA 02114, USA.
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Chuang CW, Tsai PS, Lin JA, Meganathan N, Fan YC, Yuan HB, Kao MC, Huang CJ. Increased Subsequent Risk of Coronary Heart Disease in Primary Cesarean Delivery Women: A Population-Based Cohort Study. J Womens Health (Larchmt) 2018; 28:323-330. [PMID: 30212255 DOI: 10.1089/jwh.2017.6879] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Impacts of delivery modes on the subsequent risk of coronary heart disease (CHD) in pregnant women have not been elucidated. MATERIALS AND METHODS Data of women who had undergone cesarean delivery (CD cohort) or vaginal delivery (VD cohort) between January 2000 and December 2012 from Taiwan Health Insurance Database were analyzed. All subjects were tracked until December 31, 2013. For women with multiple deliveries, only the first delivery data were included. Study end point was the diagnosis of new-onset CHD after delivery. RESULTS In total, 51,765 subjects (CD cohort: n = 17,839; VD cohort: n = 33,926) were included. During 1-14 years of follow-up, the incidence rate of new-onset CHD in the CD cohort was significantly higher than in the VD cohort (1.3% [231/17,839] vs. 0.8% [257/33,926], p < 0.001; effect size: 0.30). Analysis revealed that the subsequent risk of CHD in the CD cohort was significantly higher than in the VD cohort (adjusted hazard ratio [HR] = 1.28, 95% confidence intervals [CI]: 1.06-1.55, p = 0.012). We performed sensitivity tests by excluding subjects who had undergone CD due to nonmedical reasons from the CD cohort. The remaining subjects were named as the *CD cohort. Analysis also revealed a higher subsequent risk of CHD in the *CD cohort than in the VD cohort (adjusted HR = 1.32, 95% CI: 1.08-1.60, p = 0.006). CONCLUSIONS Women who had undergone primary CD, especially those who had undergone CD due to medical reasons, were associated with an ∼30% higher risk of CHD than those who had undergone VD.
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Affiliation(s)
- Ching-Wei Chuang
- 1 Departments of Anesthesiology, Taipei Tzu Chi Hospital, Xindian District, New Taipei City, Taiwan
| | - Pei-Shan Tsai
- 2 School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Jui-An Lin
- 3 Department of Anesthesiology, Wan Fang Hospital, Taipei Medical University, Wenshan District, Taipei, Taiwan.,4 Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Nandini Meganathan
- 1 Departments of Anesthesiology, Taipei Tzu Chi Hospital, Xindian District, New Taipei City, Taiwan
| | - Yen-Chun Fan
- 3 Department of Anesthesiology, Wan Fang Hospital, Taipei Medical University, Wenshan District, Taipei, Taiwan
| | - Hui-Bih Yuan
- 1 Departments of Anesthesiology, Taipei Tzu Chi Hospital, Xindian District, New Taipei City, Taiwan
| | - Ming-Chang Kao
- 1 Departments of Anesthesiology, Taipei Tzu Chi Hospital, Xindian District, New Taipei City, Taiwan
| | - Chun-Jen Huang
- 3 Department of Anesthesiology, Wan Fang Hospital, Taipei Medical University, Wenshan District, Taipei, Taiwan.,5 Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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Terón I, Eng MS, Katz JM. Causes and Treatment of Acute Ischemic Stroke During Pregnancy. Curr Treat Options Neurol 2018; 20:21. [PMID: 29785465 DOI: 10.1007/s11940-018-0506-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE OF REVIEW Treatment recommendations for pregnancy associated ischemic stroke are scarce. This may be due to the fact that, in general, obstetricians tend not to make recommendations for stroke patients and neurologists are not commonly involved in the care of pregnant women. Herein, we review the multiple etiologies of ischemic stroke during pregnancy, considerations for diagnostic testing, and acute treatment and prevention options, including associated risks specific to the pregnant and puerperal state. RECENT FINDINGS Intravenous tissue plasminogen activator (tPA) and endovascular thrombectomy have been used successfully to treat pregnant women with acute ischemic stroke. Recent national guidelines recommend considering tPA use during pregnancy for moderate and severe strokes if the potential benefits offset the risks of uterine hemorrhage. Pregnancy-associated ischemic stroke is rare, but can be devastating, and recanalization therapy should not be systematically withheld. Women who are at risk for stroke should be followed carefully, and providers caring for pregnant women should be educated regarding stroke signs and symptoms. Many of the standard post stroke diagnostic modalities may be used safely in pregnancy, and primary and secondary stroke prevention therapy must be tailored to avoid fetal toxicity.
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Affiliation(s)
- Ina Terón
- Department of Neurology, North Shore University Hospital and Zucker School of Medicine at Hofstra/Northwell, and Feinstein Institute for Medical Research, 300 Community Drive, 9 Tower, Manhasset, NY, 11030, USA.
| | | | - Jeffrey M Katz
- Department of Neurology, North Shore University Hospital and Zucker School of Medicine at Hofstra/Northwell, and Feinstein Institute for Medical Research, 300 Community Drive, 9 Tower, Manhasset, NY, 11030, USA.,Department of Radiology, North Shore University Hospital and Zucker School of Medicine at Hofstra/Northwell, and Feinstein Institute for Medical Research, Hempstead, NY, 11549, USA
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11
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Sanders BD, Davis MG, Holley SL, Phillippi JC. Pregnancy-Associated Stroke. J Midwifery Womens Health 2018; 63:23-32. [PMID: 29369478 DOI: 10.1111/jmwh.12720] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 10/13/2017] [Accepted: 10/22/2017] [Indexed: 10/18/2022]
Abstract
Cerebrovascular accident, or stroke, is the fourth leading cause of death for all women and the eighth leading cause of pregnancy-associated death. The physiologic changes of pregnancy increase the risk of cerebrovascular accident for women. With current incidence rates, a facility with 3300 births per year can anticipate caring for one woman with a pregnancy-related stroke at least every 2 years. All maternity care providers must be able to assess women experiencing stroke-like symptoms and initiate timely care to mitigate brain tissue damage, decrease long-term morbidity, and prevent mortality. The 2 main types of stroke, ischemic and hemorrhagic, have similar presenting symptoms but very different pathophysiology and treatment. This article reviews assessment and initial treatment of pregnant and postpartum women experiencing stroke and provides guidance for subsequent maternity and primary care to assist front-line perinatal care providers who may be the first to treat affected women or may resume primary care after diagnosis.
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Cheng CA, Lee JT, Lin HC, Lin HC, Chung CH, Lin FH, Tsao CH, Wu YF, Chien WC, Chiu HW. Pregnancy increases stroke risk up to 1 year postpartum and reduces long-term risk. QJM 2017; 110:355-360. [PMID: 28069909 DOI: 10.1093/qjmed/hcw222] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND : The incidence of stroke in pregnant women is low but trending upward. There are few studies of the topic in women of Asian ethnicity. AIM We aim to evaluate stroke risk in Asian women during and after pregnancy. DESIGN : Using the Taiwan National Health Insurance database, we designed a retrospective study that included 18-45-year-old pregnant women between the years 2000 and 2010. We selected a 1:1 age-matched control group of non-pregnant women. The endpoint was any type of stroke during pregnancy or the postpartum period; otherwise, the patients were tracked until 31 December 2010. METHODS : The risk factors for stroke were found using Cox proportional regression to calculate the hazard ratio (HR) with a 95% CI compared with the control group. RESULTS : The incidence of stroke within 1 year postpartum was 71/100,000. The risk of postpartum stroke within 1 year was an HR of 1.208 (95% CI: 1.001-5.129). The occurrence of stroke was associated with hypertension, diabetes mellitus, coagulation disorders, migraine, obesity, cerebrovascular malformation and parity. Women with third and fourth parity carried increased risks of 13.3% and 2.5%, respectively, compared with first parity women. In long-term follow-ups, stroke risk was significantly lower, with an adjusted HR of 0.362 (95% CI: 0.269-0.489). CONCLUSION The risk of stroke was elevated during the first year postpartum, but lower in subsequent years. Stroke risk increased in multiparous (≥3) women. Physicians should be on alert for pregnancy complications and ensure appropriate management to prevent postpartum stroke.
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Affiliation(s)
- Chun-An Cheng
- From the Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- Graduate Institute of Biomedical Informatics, Taipei Medical University, Taipei, Taiwan
| | - Jiunn-Tay Lee
- From the Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Hung-Che Lin
- Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Hui-Chen Lin
- From the Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chi-Hsiang Chung
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- Department of Health Duties and Chronic Epidemiology, School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Fu-Huang Lin
- Department of Health Duties and Chronic Epidemiology, School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Chang-Huei Tsao
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yung-Fu Wu
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Wu-Chien Chien
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- Department of Health Duties and Chronic Epidemiology, School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Hung-Wen Chiu
- Graduate Institute of Biomedical Informatics, Taipei Medical University, Taipei, Taiwan
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Caso V, Falorni A, Bushnell CD, Acciarresi M, Remohí J, Sprigg N, Gerli S. Pregnancy, Hormonal Treatments for Infertility, Contraception, and Menopause in Women After Ischemic Stroke. Stroke 2017; 48:501-506. [DOI: 10.1161/strokeaha.116.013964] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 10/31/2016] [Accepted: 11/21/2016] [Indexed: 11/16/2022]
Affiliation(s)
- Valeria Caso
- From the Stroke Unit, Department of Vascular and Cardiovascular Medicine, Santa Maria della Misericordia Hospital (V.C., M.A.), Department of Medicine, Section of Internal Medicine and Endocrine and Metabolic Sciences (A.F.), and Department of Surgical and Biomedical Sciences, Section of Obstetrics and Gynecology (S.G.), University of Perugia, Italy; Department of Neurology, Wake Forest Baptist Medical Center, Winston-Salem, NC (C.D.B.); Instituto Valenciano de Infertilidad, Universidad de Valencia,
| | - Alberto Falorni
- From the Stroke Unit, Department of Vascular and Cardiovascular Medicine, Santa Maria della Misericordia Hospital (V.C., M.A.), Department of Medicine, Section of Internal Medicine and Endocrine and Metabolic Sciences (A.F.), and Department of Surgical and Biomedical Sciences, Section of Obstetrics and Gynecology (S.G.), University of Perugia, Italy; Department of Neurology, Wake Forest Baptist Medical Center, Winston-Salem, NC (C.D.B.); Instituto Valenciano de Infertilidad, Universidad de Valencia,
| | - Cheryl D. Bushnell
- From the Stroke Unit, Department of Vascular and Cardiovascular Medicine, Santa Maria della Misericordia Hospital (V.C., M.A.), Department of Medicine, Section of Internal Medicine and Endocrine and Metabolic Sciences (A.F.), and Department of Surgical and Biomedical Sciences, Section of Obstetrics and Gynecology (S.G.), University of Perugia, Italy; Department of Neurology, Wake Forest Baptist Medical Center, Winston-Salem, NC (C.D.B.); Instituto Valenciano de Infertilidad, Universidad de Valencia,
| | - Monica Acciarresi
- From the Stroke Unit, Department of Vascular and Cardiovascular Medicine, Santa Maria della Misericordia Hospital (V.C., M.A.), Department of Medicine, Section of Internal Medicine and Endocrine and Metabolic Sciences (A.F.), and Department of Surgical and Biomedical Sciences, Section of Obstetrics and Gynecology (S.G.), University of Perugia, Italy; Department of Neurology, Wake Forest Baptist Medical Center, Winston-Salem, NC (C.D.B.); Instituto Valenciano de Infertilidad, Universidad de Valencia,
| | - José Remohí
- From the Stroke Unit, Department of Vascular and Cardiovascular Medicine, Santa Maria della Misericordia Hospital (V.C., M.A.), Department of Medicine, Section of Internal Medicine and Endocrine and Metabolic Sciences (A.F.), and Department of Surgical and Biomedical Sciences, Section of Obstetrics and Gynecology (S.G.), University of Perugia, Italy; Department of Neurology, Wake Forest Baptist Medical Center, Winston-Salem, NC (C.D.B.); Instituto Valenciano de Infertilidad, Universidad de Valencia,
| | - Nikola Sprigg
- From the Stroke Unit, Department of Vascular and Cardiovascular Medicine, Santa Maria della Misericordia Hospital (V.C., M.A.), Department of Medicine, Section of Internal Medicine and Endocrine and Metabolic Sciences (A.F.), and Department of Surgical and Biomedical Sciences, Section of Obstetrics and Gynecology (S.G.), University of Perugia, Italy; Department of Neurology, Wake Forest Baptist Medical Center, Winston-Salem, NC (C.D.B.); Instituto Valenciano de Infertilidad, Universidad de Valencia,
| | - Sandro Gerli
- From the Stroke Unit, Department of Vascular and Cardiovascular Medicine, Santa Maria della Misericordia Hospital (V.C., M.A.), Department of Medicine, Section of Internal Medicine and Endocrine and Metabolic Sciences (A.F.), and Department of Surgical and Biomedical Sciences, Section of Obstetrics and Gynecology (S.G.), University of Perugia, Italy; Department of Neurology, Wake Forest Baptist Medical Center, Winston-Salem, NC (C.D.B.); Instituto Valenciano de Infertilidad, Universidad de Valencia,
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14
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Miller EC, Yaghi S, Boehme AK, Willey JZ, Elkind MSV, Marshall RS. Mechanisms and outcomes of stroke during pregnancy and the postpartum period: A cross-sectional study. Neurol Clin Pract 2016; 6:29-39. [PMID: 26918201 DOI: 10.1212/cpj.0000000000000214] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Pregnancy-associated stroke remains incompletely characterized because of the rarity of these potentially devastating events. We investigated whether mechanism and outcome of ischemic pathophysiology stroke differ between young pregnant and nonpregnant women. METHODS We identified 135 consecutive women ages 18-40 years admitted to our center from January 2008 through June 2014 with ischemic stroke, TIA, cerebral venous thrombosis, or nonaneurysmal subarachnoid hemorrhage due to reversible cerebral vasoconstriction syndrome (RCVS). We reviewed charts for pregnancy status, demographics, medical comorbidities, stroke severity, etiology, and discharge outcomes. RESULTS There were 33 women with pregnancy-associated stroke (PAS) and 102 with non-pregnancy-associated stroke (NPAS). Among women with PAS, 73% of strokes occurred postpartum. In the PAS group, the most common cause of cerebrovascular events was RCVS (n = 12), 11 postpartum and 4 in women with preeclampsia. There were no significant differences between the groups in demographics. Women with PAS were less likely to have vascular risk factors such as hyperlipidemia and history of thromboembolism but more likely to have cerebral venous thromboses (21% vs 7%, p = 0.02). Women with PAS were more likely to have RCVS as stroke mechanism (36% vs 1%, odds ratio 57.7, 95% confidence interval 7-468, p = 0.0001). CONCLUSION Compared with nonpregnant women of the same age group, women with PAS had fewer vascular risk factors. Cerebral venous thrombosis and RCVS were more common in PAS, most of which occurred postpartum. These results provide further evidence for the unique pathophysiology of pregnancy-related stroke, raising important questions for future investigation.
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Affiliation(s)
- Eliza C Miller
- Department of Neurology (ECM, SY, AKB, JZW, MSVE, RSM), College of Physicians and Surgeons, and Department of Epidemiology (AKB, MSVE), Mailman School of Public Health, Columbia University, New York, NY
| | - Shadi Yaghi
- Department of Neurology (ECM, SY, AKB, JZW, MSVE, RSM), College of Physicians and Surgeons, and Department of Epidemiology (AKB, MSVE), Mailman School of Public Health, Columbia University, New York, NY
| | - Amelia K Boehme
- Department of Neurology (ECM, SY, AKB, JZW, MSVE, RSM), College of Physicians and Surgeons, and Department of Epidemiology (AKB, MSVE), Mailman School of Public Health, Columbia University, New York, NY
| | - Joshua Z Willey
- Department of Neurology (ECM, SY, AKB, JZW, MSVE, RSM), College of Physicians and Surgeons, and Department of Epidemiology (AKB, MSVE), Mailman School of Public Health, Columbia University, New York, NY
| | - Mitchell S V Elkind
- Department of Neurology (ECM, SY, AKB, JZW, MSVE, RSM), College of Physicians and Surgeons, and Department of Epidemiology (AKB, MSVE), Mailman School of Public Health, Columbia University, New York, NY
| | - Randolph S Marshall
- Department of Neurology (ECM, SY, AKB, JZW, MSVE, RSM), College of Physicians and Surgeons, and Department of Epidemiology (AKB, MSVE), Mailman School of Public Health, Columbia University, New York, NY
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15
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Attenuation of cardiovascular stress response to endotracheal intubation by the use of remifentanil in patients undergoing Cesarean delivery. J Anesth 2015; 30:274-83. [DOI: 10.1007/s00540-015-2118-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 12/01/2015] [Indexed: 12/19/2022]
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16
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Razmara A, Bakhadirov K, Batra A, Feske SK. Cerebrovascular complications of pregnancy and the postpartum period. Curr Cardiol Rep 2015; 16:532. [PMID: 25239155 DOI: 10.1007/s11886-014-0532-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Cerebrovascular complications of pregnancy, though uncommon, threaten women with severe morbidity or death, and they are the main causes of major long-term disability associated with pregnancy. In this review, we discuss the epidemiology, pathophysiology, presentation and diagnosis, and management and outcomes of ischemic and hemorrhagic stroke and cerebral venous thrombosis. We also discuss the posterior reversible encephalopathy syndrome, the reversible cerebral vasoconstriction syndrome including postpartum cerebral angiopathy, and their relationship as overlapping manifestations of pre-eclampsia-eclampsia.
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Affiliation(s)
- Ali Razmara
- Fellow in Vascular Neurology, Massachusetts General and Brigham and Women's Hospitals, Boston, MA, USA,
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17
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Ko YL, Chen CP, Lin PC. Physical activities during pregnancy and type of delivery in nulliparae. Eur J Sport Sci 2015; 16:374-80. [PMID: 25837804 DOI: 10.1080/17461391.2015.1028468] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The aim of this study was to investigate changes in physical activity across pregnancy and the relationship between trimester-specific physical activity and unplanned caesarean sections (CSs). A cohort study design was carried out. A cohort of 150 pregnant women was established when they received prenatal care at 29-40 weeks of gestation at a medical centre in northern Taiwan. Participants were asked to recall the amounts of physical activity in which they had engaged in the three trimesters as assessed by the Pregnancy Physical Activity Questionnaire (PPAQ). Overall self-reported physical activity for the cohort decreased by 31% in the first trimester compared to the pre-gravid period, then increased in the second trimester and remained stable until delivery. A repeated measures analysis of variance was used to evaluate the data and revealed significantly more physical activity during the second trimester than in the first and third trimesters (F = 36.471, P = 0.000). In addition, there was a significant difference between normal spontaneous delivery and unplanned CS groups (F = 4.770, P = 0.031). Logistic regression determined that the odds ratio of undergoing a CS increased by 0.644 (95% confidence interval: 0.429-0.968) for women in the third trimester who performed low levels of physical activity. Results support the benefits of physical activity, and professionals are encouraged to provide pregnant women with information on recommendations for physical activity, particularly in terms of reducing unplanned CSs.
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Affiliation(s)
- Yi-Li Ko
- a Department of Nursing , College of Medicine, Fu Jen Catholic University , Hsin-chuang City , Taiwan , Republic of China
| | - Chie-Pein Chen
- b Department of Obstetrics and Gynecology , Mackay Memorial Hospital , Taipei City , Taiwan , Republic of China
| | - Pi-Chu Lin
- c Master Program in Long-term Care and School of Nursing , College of Nursing, Taipei Medical University , Taipei , Taiwan , Republic of China
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18
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Moatti Z, Gupta M, Yadava R, Thamban S. A review of stroke and pregnancy: incidence, management and prevention. Eur J Obstet Gynecol Reprod Biol 2014; 181:20-7. [PMID: 25124706 DOI: 10.1016/j.ejogrb.2014.07.024] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 07/20/2014] [Indexed: 02/07/2023]
Abstract
Stroke, defined as a focal or global disturbance of cerebral function lasting over 24h resulting from disruption of its blood supply, is a devastating event for a pregnant woman. This can result in long-term disability or death, and impact on her family and unborn child. In addition to pre-existing patient risk factors, the hypercoagulable state and pre-eclampsia need to be taken into account. The patterns and types of stroke affect pregnant women differ from the non-pregnant female population of child-bearing age. Like other thrombo-embolic diseases in pregnancy, stroke is essentially a disease of the puerperium. Population studies have estimated the risk of stroke at between 21.2 and 46.2 per 100,000. The US Nationwide Inpatient Sample, identified 2850 pregnancies complicated by stroke in the United States in 2000-2001, for a rate of 34.2 per 100,000 deliveries. There were 117 deaths, a mortality rate of 1.4 per 100,000. Both the mortality and disability rates were higher than previously reported, with 10-13% of women dying. With the increasing prevalence of obesity, hypertension and cardiac disease amongst women of child-bearing age, so is the incidence of stroke during pregnancy and the puerperium. In the United States, an alarming trend toward higher numbers of stroke hospitalizations during the last decade was demonstrated in studies from 1995 to 1996 and 2006 to 2007. The rate of all types of stroke increased by 47% among antenatal hospitalizations, and by 83% among post-partum hospitalizations. Hypertensive disorders, obesity and heart disease complicated 32% of antenatal admissions and 53% of post-partum admissions. In addition to pre-existing patient risk factors, the hypercoagulable state and pre-eclampsia need to be taken into account. The patterns and types of stroke affect pregnant women differ from the non-pregnant female population of child-bearing age. Like other thrombo-embolic diseases in pregnancy, stroke is essentially a disease of the puerperium.
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Affiliation(s)
- Zoe Moatti
- Specialist Registrar Obstetrics and Gynaecology, Whipps Cross University Hospital, Whipps Cross Road, London E11 1NR, United Kingdom.
| | - Manish Gupta
- Consultant Obstetrician and Gynaecologist and Subspecialist in Maternal and Fetal Medicine, Barts and The Royal London NHS Trust, Whipps Cross University Hospital, Whipps' Cross Road, London E11 1NR, United Kingdom
| | - Rajendra Yadava
- Consultant Physician, Stroke Specialist, Barts and The Royal London NHS Trust, Whipps Cross University Hospital, Whipps' Cross Road, London E11 1NR, United Kingdom
| | - Sujatha Thamban
- Consultant Obstetrician and Gynaecologist at The Royal London Hospital, Barts and The Royal London NHS Trust, Whipps Cross University Hospital, Whipps' Cross Road, London E11 1NR, United Kingdom
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19
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Ko YL, Lin PC, Chen SC. Stress, sleep quality and unplanned Caesarean section in pregnant women. Int J Nurs Pract 2014; 21:454-61. [PMID: 24754483 DOI: 10.1111/ijn.12267] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This study examines the relationship among prenatal maternal stress, sleep quality and unplanned Caesarean delivery. For this research, we adopted a prospective survey design and a sample of 200 women in the early stages of labour. The findings were as follows: (i) 11.5% of the participants underwent unplanned Caesarean sections; (ii) based on a Pittsburg Sleep Quality Index split point of 5, approximately 90.5% of the participants experienced poor sleep quality; and (iii) the odds ratio for primiparas undergoing an unplanned Caesarean section was 4.183 times that for multiparas (95% confidence interval (CI) = 1.177 to 14.864), indicating a statistically significant difference. The results also showed that stress was a significant factor related to unplanned Caesarean sections; a 1-point increase on the Pregnancy Stress Rating Scale was associated with a 1.033-fold higher probability of undergoing an unplanned Caesarean section (95% CI = 1.002 to 1.065). Furthermore, prenatal stress was a significant variable that can be used to predict unplanned Caesarean deliveries.
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Affiliation(s)
- Yi-Li Ko
- Department of Nursing, College of Medicine, Fu Jen Catholic University, Taiwan
| | - Pi-Chu Lin
- School of Nursing, College of Nursing, Taipei Medical University, Taiwan
| | - Shu-Chuan Chen
- Nursing Department, Shin Kong Wu Ho-Su Memorial Hospital, Taiwan
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20
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Tang SC, Jeng JS. Management of stroke in pregnancy and the puerperium. Expert Rev Neurother 2014; 10:205-15. [DOI: 10.1586/ern.09.126] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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21
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Grear KE, Bushnell CD. Stroke and pregnancy: clinical presentation, evaluation, treatment, and epidemiology. Clin Obstet Gynecol 2013; 56:350-9. [PMID: 23632643 PMCID: PMC3671374 DOI: 10.1097/grf.0b013e31828f25fa] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Stroke is a neurological emergency that carries a risk of morbidity and mortality. Recent studies have shown that the incidence of stroke, although rare, is increasing in pregnant females. In this review, stroke and other vasculopathies in the pregnant and postpartum female are examined. A discussion of the symptoms and clinical presentation of stroke is provided and the current guideline for treatment of stroke in pregnancy. Finally, the data illustrating the recent increases in stroke incidence are outlined.
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Affiliation(s)
- Karrie E Grear
- Department of Neurology, Wake Forest School of Medicine, Winston Salem, North Carolina, USA
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22
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HEESEN M, KLÖHR S, HOFMANN T, ROSSAINT R, DEVROE S, STRAUBE S, VAN DE VELDE M. Maternal and foetal effects of remifentanil for general anaesthesia in parturients undergoing caesarean section: a systematic review and meta-analysis. Acta Anaesthesiol Scand 2013; 57:29-36. [PMID: 22724620 DOI: 10.1111/j.1399-6576.2012.02723.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND Remifentanil has been suggested for the induction of general anaesthesia for caesarean section. We aimed to define remifentanil effects on maternal stress response as well as neonatal effects. METHODS Relevant articles were retrieved by a systematic literature search. Randomized, controlled trials comparing remifentanil use before delivery with placebo were selected. Maternal outcome parameters were blood pressure and heart rate; neonatal effects included the need for mask ventilation and intubation, base excess, pH values, Apgar < 7 at 1 and 5 min. The random effects model was used for meta-analysis; risk ratio or weighted mean difference (WMD) and 95% confidence interval (95% CI) were calculated. RESULTS Five articles including 186 patients were identified. Highest and lowest systolic blood pressure were significantly lower in the remifentanil group (WMD: -29.98, -50.90 to -9.07 mmHg, 95% CI; P = 0.005; and WMD: -12.46, -18.21 to -6.71 mmHg, 95% CI; P < 0.0001), the lowest heart rate was significantly lower after remifentanil treatment (WMD: -8.22, -11.67 to -4.78, 95% CI; P < 0.00001). Base excess was significantly higher in infants of remifentanil-treated mothers (WMD: 1.15, -0.27 to 2.03, 95% CI; P = 0.01); pH was also higher in the remifentanil group, but significance was missed (P = 0.07). No differences were observed for Apgar values or the need of airway assist. CONCLUSION Remifentanil was found to attenuate the maternal circulatory response to intubation and surgery. Higher base excess and pH suggest a beneficial effect on the neonatal acid-base status. A trial with adequate power is warranted that addresses neonatal side-effects of remifentanil.
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Affiliation(s)
- M. HEESEN
- Department of Anaesthesia; Klinikum Bamberg; Bamberg; Germany
| | - S. KLÖHR
- Department of Anaesthesia; Klinikum Bamberg; Bamberg; Germany
| | - T. HOFMANN
- Department of Anaesthesia; Klinikum Bamberg; Bamberg; Germany
| | - R. ROSSAINT
- Department of Anaesthesia; Universitätsklinkum Aachen; Aachen; Germany
| | - S. DEVROE
- Department of Anaesthesia; Universitair Zieckenhuis Leuven; Leuven; Belgium
| | - S. STRAUBE
- Department of Occupational, Social and Environmental Medicine; University Medical Center Göttingen; Göttingen; Germany
| | - M. VAN DE VELDE
- Department of Anaesthesia; Universitair Zieckenhuis Leuven; Leuven; Belgium
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23
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Huang CJ, Fan YC, Tsai PS. Differential impacts of modes of anaesthesia on the risk of stroke among preeclamptic women who undergo Caesarean delivery: a population-based study. Br J Anaesth 2010; 105:818-26. [DOI: 10.1093/bja/aeq266] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
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24
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Ma KZM, Norton EC, Lee SYD. Declining fertility and the use of cesarean delivery: evidence from a population-based study in Taiwan. Health Serv Res 2010; 45:1360-75. [PMID: 20545781 DOI: 10.1111/j.1475-6773.2010.01125.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To test the hypothesis that declining fertility would affect the number of cesarean sections (c-sections) on maternal demand, but not medically indicated c-sections. DATA SOURCES The 1996-2004 National Health Insurance Research Database in Taiwan for all singleton deliveries. STUDY DESIGN Retrospective population-based, longitudinal study. Estimation was performed using multinomial probit models. PRINCIPAL FINDINGS Results revealed that declining fertility had a significant positive effect on the probability of having a c-section on maternal request but not medically indicated c-section. CONCLUSIONS Our findings offer a precautionary note to countries experiencing a fertility decline. Policies to contain the rise of c-sections should understand the role of women's preferences, especially regarding cesarean deliveries on maternal request.
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Affiliation(s)
- Ke-Zong M Ma
- Graduate Institute of Healthcare Administration, Kaohsiung Medical University, 100 Shih-Chuan 1st Road, Kaohsiung 80708, Taiwan.
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25
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Current world literature. Curr Opin Anaesthesiol 2009; 22:447-56. [PMID: 19417565 DOI: 10.1097/aco.0b013e32832cbfed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This bibliography is compiled by clinicians from the journals listed at the end of this publication. It is based on literature entered into our database between 1 February 2008 and 31 January 2009 (articles are generally added to the database about two and a half months after publication). In addition, the bibliography contains every paper annotated by reviewers; these references were obtained from a variety of bibliographic databases and published between the beginning of the review period and the time of going to press. The bibliography has been grouped into topics that relate to the reviews in this issue.
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26
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Reply. Am J Obstet Gynecol 2009. [DOI: 10.1016/j.ajog.2008.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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27
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The evidence that shows that stroke and cesarean section are associated needs to be critically reviewed. Am J Obstet Gynecol 2009; 200:e15; author reply e15. [PMID: 19019332 DOI: 10.1016/j.ajog.2008.08.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2008] [Accepted: 08/08/2008] [Indexed: 11/22/2022]
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28
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Zeldes K, Norsigian J. Encouraging women to consider a less medicalized approach to childbirth without turning them off: challenges to producing Our Bodies, Ourselves: Pregnancy and Birth. Birth 2008; 35:245-9. [PMID: 18844651 DOI: 10.1111/j.1523-536x.2008.00246.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Within the United States, women routinely confront negative and distorted ideas about birth, and highly medicalized births are the norm. The writers and editors of Our Bodies, Ourselves: Pregnancy and Birth discuss their efforts to write a book that provides women with accessible, evidence-based information; examines the social, economic, and political factors that shape and constrain childbirth choices; and inspires women to work toward ensuring that all women have access to the full range of safe and satisfying birthing options.
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