Pregnant stroke pt!?!?!?!?!

[TonyaM73]

Ok, got a very different pt the other day: Early thirties, 4 wks pregnant with numbness and tingling down right arm, leg and right side of face. CT negative, but MRI not done due to pt refusing and MDs worried about how MRI would effect pregnancy. Symptoms dissappeared within a few hours of onset, but pt admitted to med/surg (stroke unit).

Ok, all are thinking maybe anxiety, but playing it cautious due to classic stroke symptoms. ECHO comes back positive for bubble!!!! :redlight: Waiting for carotid us. Would you have pushed for the MRI? Would you have given Lovenox to a pregnant woman this early in gestation?

Honestly, everything we would normally have done for a stroke pt, we had to take a step back and wonder how this would effect the baby. Everyone was playing it very, very cautious, which we definatley should! Has anyone else had a similar experience or do you know of any research concerning stroke and pregnancy? I am going to look around the net today, but I love hearing from you guys, so asking here first.

Sorry, I put this in med/surg too and meant to put it in here.

[Sandwitch883RN]

So much focus is put on a mom being preganant that sometimes providers lose sight of the fact that if mom dies, so does baby. Not to say protecting the fetus is not important, and may call for some modification of tx, but if mom dies so does baby. I had a pt show up to L&D triage with a severe asthma attack. She should have gone to the ED but came to L&D first. We could have treated her if need be, but for non OB related emergencies they go to the ER first in our facility. The ER staff was upset because she was pregnant. Once they stabalized her asthma, we followed up in our triage with and NST and OB focused assessment.

[TonyaM73, ASN, RN]

Sometimes the crossovers can be the hardest to treat. We are so used to our specialties that when something like a stroke comes around...I have no problem treating it, but this was the first time I had a pregnant pt with stroke and really had not thought of the ramifications of what we do to treat stroke on a fetus.

If she had been full blown stroke with deficites and what not, I don't think we would have hesitated in treatment. Since it was a possible TIA that was so brief with the symptoms, we worried that maybe it was anxiety and not a TIA. Then you question "do we really need to do the full workup if there is a possiblity of harming the fetus?"

I read the information that was linked in a couple of posts and they were very helpful. Thank you. I am currently trying to find case studies that focused on stroke and pregnancy. I have seen one thus far and it seemed to be a good outcome.

Thanks to everyone for their input. I love getting everyone's educated opinions on here!

[Elvish, BSN, DNP, RN, NP]

So much focus is put on a mom being preganant that sometimes providers lose sight of the fact that if mom dies, so does baby. Not to say protecting the fetus is not important, and may call for some modification of tx, but if mom dies so does baby. I had a pt show up to L&D triage with a severe asthma attack. She should have gone to the ED but came to L&D first. We could have treated her if need be, but for non OB related emergencies they go to the ER first in our facility. The ER staff was upset because she was pregnant. Once they stabalized her asthma, we followed up in our triage with and NST and OB focused assessment.

Absolutely.

I was in a bad rollover MVA a little over a year ago and had just miscarried less than a month prior. I took an ambulance ride to the ED, where the nice ED folks (doing their job) asked me if I thought I could be pregnant. My reply: "I guess anything's possible, but I doubt it, since I just had a miscarriage 3.5 weeks ago." Them: "Here, pee in this cup anyway just to be sure." Voila! Pregnant. I didn't know at that point if the miscarriage had been twins and I'd lost one or if this was a new pregnancy, or if it was 'leftovers' from the miscarriage (which I highly doubted and was right). They treated it like a new pregnancy (which OB confirmed a couple weeks later).

Anyway, the ED doc ordered a chest X-ray and head/neck CT. I had to make a decision whether or not to allow them to do it knowing I was pregnant, albeit early. My thinking was along the same lines. There's a certain chance of a bad outcome to have a mother with a brain bleed or dissecting great vessel. To be sure, I sat on pins and needles for many weeks praying the radiation hadn't hurt my daughter, even though I knew that that early, insults are usually an all-or-nothing proposition, and I was double-shielded. I was terrified the radiation had horribly messed up the cell division that was so rapidly happening at that point. Fortunately, all my tests (other than the hCG :) ) were negative, and she is now a healthy chunky 4-month-old.

I realize that's not quite the same as a stroke or an asthma attack, but pregnant is pregnant. There is plenty out there that in theory isn't good for a developing baby at any gestation but things like airways or brains or bleeding are involved, it kind of trumps the rest.

[TonyaM73, ASN, RN]

WOW Elvish! I am so glad that everyone is safe and healthy. I would have chewed my nails to bits throughout the entire pregnancy. I worry about this pt and wonder what if anything can be done. Didn't have any confirmation that it ws a TIA, but with the positive bubble there is a distinct possibility. The only problem with med/surg is that since I don't work again until Thursday, I may never know. OH well, if all it did for me was get me to learn more, then the next pt will get the benifit. :)

[jamieslovingmom]

Yes, I know that mom's life is the priority. I just thought it was odd that the op stated that the doc didn't want to do MRI because of potential risk to the fetus. MRI doesn't emit radiation, so it should be less of a risk.

[xtxrn, ASN, RN]

A friend's daughter lost two babies in the late 2nd trimester....sent one to autopsy, and got info re: hypercoagulopathy during pregnancy.... She got pregnant again, and was on Lovenox most of the pregnancy. Baby was born healthy. She got pregnant a bit over a year after the last baby was born....more Lovenox.....healthy twins full term at over 6 pounds each.

Depends on the issue and individual. :)