Stroke During Pregnancy: Warning Signs and Early Treatment

Stroke is often thought of as a condition affecting older people, but it can also occur during pregnancy and in the weeks following childbirth.

Although pregnancy-related stroke is uncommon, the physical changes that occur during pregnancy increase the risk. Early recognition of warning signs and prompt treatment can significantly reduce the likelihood of serious complications for both mother and baby.

Why does pregnancy increase the risk of stroke?

During pregnancy, the body undergoes many natural changes to support a growing baby. These include:

• An increase in blood volume, placing greater demands on the heart and blood vessels.
• Blood becoming more likely to clot, helping to reduce blood loss during childbirth.
• Hormonal changes affecting the cardiovascular system.
• An increased risk of high blood pressure and pre-eclampsia.

While these changes are normal, they can increase the risk of both ischaemic stroke (caused by a blood clot) and haemorrhagic stroke (caused by bleeding into the brain), particularly during late pregnancy and in the first few weeks after delivery.

What conditions can increase the risk?

Several pregnancy-related conditions are associated with stroke, including:

• Pre-eclampsia

Pre-eclampsia is characterised by high blood pressure and signs that other organs, such as the kidneys or liver, are being affected. If left untreated, severe hypertension can damage blood vessels within the brain and lead to a stroke. It may also progress to eclampsia, causing seizures and other life-threatening complications.

• Cerebral Venous Sinus Thrombosis (CVST)

Pregnancy increases the body's tendency to form blood clots. In rare cases, a clot can develop in the veins that drain blood from the brain, a condition known as cerebral venous sinus thrombosis (CVST). Early diagnosis and treatment with anticoagulant medication can often prevent further brain injury.

• Heart Conditions

Some women have underlying heart conditions, such as atrial fibrillation or structural abnormalities of the heart, which may increase the likelihood of blood clots travelling to the brain during pregnancy.

• Deep Vein Thrombosis (DVT)

Pregnancy also increases the risk of developing blood clots in the legs, known as deep vein thrombosis (DVT). Although a DVT most commonly causes a pulmonary embolism if the clot travels to the lungs, in rare circumstances a clot may pass through an opening in the heart and travel to the brain, resulting in a stroke.

When can things go wrong?

Many of the warning signs of stroke or serious pregnancy complications can initially appear similar to more common pregnancy symptoms.

Healthcare professionals should carefully assess symptoms such as:

• Persistent or severe headache.
• Blurred vision or flashing lights.
• Weakness affecting one side of the body.
• Difficulty speaking.
• Seizures.
• Sudden confusion.
• Severe swelling of the hands or face.
• Persistently raised blood pressure.

Depending on the circumstances, further investigations may include blood and urine tests, brain imaging, blood pressure monitoring and assessment by an obstetric or neurological specialist.

Recognising these symptoms promptly can make a significant difference to both maternal and fetal outcomes.

Example Case Study

Sophie, aged 30, was 35 weeks pregnant with her first child when she began experiencing severe headaches, blurred vision and swelling in her hands and face.

During two routine antenatal appointments, her blood pressure was noted to be increasing. She also mentioned that she had developed persistent headaches which were becoming progressively worse. Reassured that these symptoms were common during the later stages of pregnancy, she was advised to rest at home.

No senior obstetric review was arranged, and no further investigations or treatment for suspected pre-eclampsia were initiated.

Two days later, Sophie collapsed at home after suffering a haemorrhagic stroke caused by severely uncontrolled blood pressure. She underwent emergency treatment, and her baby was delivered by emergency Caesarean section.

Although both survived, Sophie was left with weakness affecting her right arm, difficulties with speech and ongoing fatigue requiring lengthy rehabilitation. Her baby required specialist neonatal care before eventually being discharged home.

Sophie's symptoms and rising blood pressure were consistent with severe pre-eclampsia. Had the condition been recognised earlier, treatment to control her blood pressure together

with timely specialist management and delivery would, on the balance of probabilities, have prevented the stroke.

Could this amount to medical negligence?

Not every pregnancy-related stroke is avoidable. Some women experience serious complications despite receiving appropriate care.

However, concerns may arise where healthcare professionals fail to:

• Recognise symptoms suggesting pre-eclampsia or other serious pregnancy complications.
• Investigate persistently raised blood pressure.
• Arrange appropriate blood and urine tests.
• Refer a patient for urgent obstetric assessment.
• Commence treatment where clinically indicated.
• Escalate care or arrange timely delivery where the risks of continuing the pregnancy outweigh the benefits.

To establish a medical negligence claim, it is generally necessary to show both that the standard of care fell below what would reasonably be expected and that earlier diagnosis or treatment would probably have prevented the stroke or significantly reduced its severity.

Recognising the warning signs can save lives

Most pregnancies result in the safe delivery of a healthy baby, but serious complications can develop quickly.

Persistent headaches, visual disturbances and high blood pressure should never be dismissed as simply part of pregnancy without appropriate assessment. Early diagnosis and treatment can dramatically reduce the risk of stroke and other life-changing complications for both mother and baby.

For families whose lives have been affected by pregnancy-related stroke, understanding whether opportunities to diagnose and treat the underlying condition were missed can be an important step towards obtaining answers and accountability.

Further Information

If you would like to learn more about stroke during pregnancy, pre-eclampsia and maternal health, the following organisations provide reliable information and support:

• Action on Pre-eclampsia (APEC), the UK's charity supporting women and families affected by pre-eclampsia.
• Stroke Association – Information and support for people affected by stroke, including younger adults and families.

If you or a family member has been affected by medical negligence, contact our specialist medical negligence lawyers; we will help you to recover appropriate compensation and secure your future.

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