目的:脑血管意外(CVA)和短暂性脑缺血发作(TIA)是育龄妇女中罕见的神经系统事件。我们的目的是比较怀孕,delivery,CVA患者和TIA患者之间的新生儿结局。
方法:使用医疗保健成本和利用项目进行了一项基于人群的回顾性队列研究,全国住院患者样本。其中包括2004年至2014年在美国分娩或孕产妇死亡的所有孕妇。我们将怀孕前或怀孕期间ICD-9诊断为CVA的女性与之前诊断为TIA的女性进行了比较,在怀孕期间,或在交付入场期间。比较两组患者的妊娠结局和围产期结局,使用多变量逻辑回归控制混杂因素。
结果:在数据库中的9,096,788名妇女中,898符合纳入标准。其中,706名女性(7.7/100,000)有CVA诊断,192例(2.1/100,000)诊断为TIA.有CVA的女人,与那些患有TIA的人相比,有较高的妊娠高血压(aOR3.82,95CI2.14-6.81,p<0.001);先兆子痫(aOR2.6,95CI1.3-5.2,p=0.007),子痫(aOR13.78,95%CI1.84-103.41,p<0.001);产后出血(aOR4.52,95CI1.31-15.56,p=0.017),输血(aOR5.57,95CI1.65-18.72,p=0.006),和产妇死亡(54vs.0例,7.6%与0%),具有可比的新生儿结局。
结论:在怀孕前或怀孕期间诊断为CVA的女性有更高的产妇并发症发生率,包括妊娠高血压疾病,产后出血,和死亡,与诊断为TIA的女性相比,具有可比的新生儿结局,强调这两种情况的不同预测,以及这些患者勤奋随访和护理的重要性。
OBJECTIVE: Cerebrovascular accidents (CVAs) and transient ischemic attacks (TIAs) are uncommon neurologic events in women of childbearing age. We aimed to compare pregnancy, delivery, and neonatal outcomes between women who suffered from a CVA and those who experienced a TIA.
METHODS: A retrospective population-based cohort study was performed using the Healthcare Cost and Utilization Project, Nationwide Inpatient Sample. Included were all pregnant women who delivered or had a maternal death in the US between 2004 and 2014. We compared women with an ICD-9 diagnosis of a CVA before or during pregnancy to those diagnosed with a TIA before, during the pregnancy, or during the delivery admission. Pregnancy and perinatal outcomes were compared between the two groups, using multivariate logistic regression to control for confounders.
RESULTS: Among 9,096,788 women in the database, 898 met the inclusion criteria. Of them, 706 women (7.7/100,000) had a CVA diagnosis, and 192 (2.1/100,000) had a TIA diagnosis. Women with a CVA, compared to those with a TIA, had a higher rate of pregnancy-induced hypertension (aOR 3.82,95%CI 2.14-6.81, p < 0.001); preeclampsia (aOR 2.6,95%CI 1.3-5.2, p = 0.007), eclampsia (aOR 13.78,95% CI 1.84-103.41, p < 0.001); postpartum hemorrhage (aOR 4.52,95%CI 1.31-15.56, p = 0.017), blood transfusion (aOR 5.57,95%CI 1.65-18.72, p = 0.006), and maternal death (54 vs. 0 cases, 7.6% vs. 0%), with comparable neonatal outcomes.
CONCLUSIONS: Women diagnosed with a CVA before or during pregnancy had a higher incidence of myriad maternal complications, including hypertensive disorders of pregnancy, postpartum hemorrhage, and death, compared to women with a TIA diagnosis, with comparable neonatal outcomes, stressing the different prognoses of these two conditions, and the importance of these patients\' diligent follow-up and care.