Headaches in pregnancy

Posterior reversible encephalopathy syndrome in the puerperium: a case report

Headache is a common presentation to the physician. Although most causes of a headache in pregnancy are benign, the pregnant woman is at risk of a life-threatening secondary headache such as eclampsia, venous sinus thrombosis or posterior reversible encephalopathy syndrome (PRES). Pregnancy and the puerperium are prothrombotic risk factors. Although the aetiology of PRES remains to be fully elucidated, hypertension with failed autoregulation results in brain oedema. An alternative hypothesis includes endothelial injury and hypoperfusion leading to an alteration in the integrity of the blood-brain barrier. It occurs in complex, systemic conditions such as pre-eclampsia, following bone marrow transplantation, chemotherapy, sepsis and autoimmune diseases. The most common clinical presentation is headache, altered alertness, seizures and visual disturbance such as hemianopia, visual neglect and cortical blindness. It can also develop in normotensive individuals. Symmetric vasogenic oedema in a watershed distribution involving the parieto-occipital regions are typically evident on MRI. Management is determined by the underlying aetiological risk factor. The authors present the case of a 32-year-old multiparous woman presenting with tonic-clonic seizures 16 days following an elective caesarean section. Her pregnancy was complicated by hypertension and headache. There was no history of pre-eclampsia. She required intubation and ventilation. The diagnosis of PRES was established on MRI. Early recognition and treatment provide a favourable prognosis as the clinical symptoms and imaging characteristics are reversible in a large cohort of affected individuals.

Acute neurological conditions during pregnancy and their management: a review

Less vascular resistance, higher vascular permeability and improved cardiac output include anatomical and physiological changes related to pregnancy. These are needed to accommodate an increase in plasma volume and ensure significant organ infusion. Nevertheless, increases in oestrogen levels may lead to an increase in the risk of coagulation and thrombosis. Increased levels of progesterone increase the risk of thrombosis due to vasodilation, vascular stasis and edoema in these situations. The increased resistance in preeclampsia maternal systemic blood arteries can create high blood pressure that can interfere with blood flow in numerous organs (including liver, kidneys, brain and placenta). The risk of issues such as pulmonary edoema, placental abruption, pneumonia of aspiration, renal failure, hepatic failure and stroke in pregnant women is increased by Preeclampsia and eclampsia. Some peripheral neuropathies (carpal tunnel syndrome, peripheral facial palsy) and central neurological conditions (seizure, migraine, stroke, epilepsy) may become more common during pregnancy because of the exacerbation of the pre-existing neurologic condition or the onset of neurological disturbance caused by pregnancy physiological changes (such as headache or vascular disorders). During the three trimesters of pregnancy, neurological disorders are both peripheral and central. Therefore, an early and correct diagnosis is required to improve pregnancy care, treatment and perinatal outcomes. The aims of this paper are to identify, define and manage the most prevalent peripheral and centrally occurring neurological disorders in the pregnancy.

Multiple Gestations and Hypertensive Disorders of Pregnancy: What Do We Know?

PURPOSE OF REVIEW

The occurrence of hypertensive disorders of pregnancy (HDP) including gestational hypertension, chronic hypertension, preeclampsia, and eclampsia is proportional to the number of fetuses: singletons 6.5%, twins 12.7%, and triplets 20.0%. Literature on HDP in multifetal gestation is sparse compared with singletons. We aim to summarize the current evidence on HDP, specifically in twins.

RECENT FINDINGS

HDP occurs more frequently, at an earlier gestational age, and can present more severely and atypically in twin pregnancies. HDP in twins carries a higher risk of maternal/fetal morbidity and mortality including renal failure, stroke, cardiac arrest, pulmonary edema, placental abruption, cesarean delivery, fetal growth restriction, and iatrogenic preterm delivery. Low-dose aspirin (60-150 mg) should be initiated in all multifetal pregnancies to reduce the risk of preeclampsia. To improve outcomes and reduce inherent risks associated with multiple gestations, twins should be managed as high-risk pregnancies, and different from singletons.