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

Nurses General Nursing

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Specializes in MED/SURG STROKE UNIT, LTC SUPER., IMU.

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!!!! :eek: :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.:nurse:

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

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

If the patient had a bubble and it wasn't a part of the test...why whould you give an anticoagulant? as that is usually an indication of ASD.

http://en.wikipedia.org/wiki/Atrial_septal_defect

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Specializes in ER/Trauma.

No stroke.

But had a pregnant woman with MASSIVE PE - ended up getting intubated after she lost respiratory function/drive.

Got tPA.

Last we know, she's happy to be alive and well (extubated next day and discharged later) and so is the baby. :)

cheers,

ETA: Here's an interesting link on thrombolysis in a pregnant stroke pt. - http://stroke.ahajournals.org/content/37/8/2168.full

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Specializes in MED/SURG STROKE UNIT, LTC SUPER., IMU.

Due to the classic stroke symptoms. We have a stroke protocal which calls for all kinds of tests, echo included and a standard set of meds including anticoagulant (lovenox or heparin and aspirin) as well as simvistatin. These are given to pts that come in with stroke symptoms and are placed on the stroke protocal. In her case, lovenox was not given and the neurologist was even concerned about giving asa without OB signing off on it. Since the pt was only 4 weeks pregnant, she did not have an OB yet.

I had not had a pt like this before and truely thought that this was an anxiety issue until the echo came back positive. With ASD, can't they produce clots with the blood shunting back and forth instead of circulating?

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Specializes in MED/SURG STROKE UNIT, LTC SUPER., IMU.
No stroke.

But had a pregnant woman with MASSIVE PE - ended up getting intubated after she lost respiratory function/drive.

Got tPA.

Last we know, she's happy to be alive and well (extubated next day and discharged later) and so is the baby. :)

cheers,

ETA: Here's an interesting link on thrombolysis in a pregnant stroke pt. - http://stroke.ahajournals.org/content/37/8/2168.full

Thank GOD! Did they find out why she had the PE or was it a fluke?

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Specializes in Community, OB, Nursery.
Thank GOD! Did they find out why she had the PE or was it a fluke?

Even in the absence of underlying clotting issues, pregnancy alone increases a woman's chance for DVT/PE. It could be either.

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Specializes in PICU, Sedation/Radiology, PACU.

Was this woman taking fertility treatments or estrogen supplements? Hish levels of estrogen increase the risk for clots (remember the warning on the birth control package?).

I had a patient during a clinical who was in her 30's and had just finished several weeks of fertility treatment and had IVF. A few days after the IVF, husband found her on the floor unable to move or speak. Rushed her to the hospital and diagnosis was an ishemic stroke. She found out a few weeks later while in the hospital that she was pregnant. She ended up recovering okay. I don't think she had regained total function by the time my rotation was over, but she was getting there. I don't believe she was receiving prophylactic anti-coagulants, though.

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Specializes in ER/Trauma.
Even in the absence of underlying clotting issues, pregnancy alone increases a woman's chance for DVT/PE.
Yep.

So a quick hint/tip of any "newbie" ED nurses reading this - if a pregnant female comes in complaining of SoB/CP/DoE or presents with hypoxia or other symptoms of cardiovascular compromise -- do your best to stick an 18g (at least - worse comes worst, you might be able to manage with a 20g) IV in the right arm antecubital.

Because dollar to donut, you can bet the Doc will want to order a CTA to rule out PE :)

- Roy

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Specializes in Family Practice.

I'm surprised they did a CT scan first...CT imaging is more harmful to a fetus than MRI because of the radiation. In an emergency, however, I guess you do what you have to do. Hope she is ok. :redpinkhe

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Specializes in MED/SURG STROKE UNIT, LTC SUPER., IMU.

Our protocal is CT first within 20 min of hitting the ED door and then follow up with MRI. CT is to see if there is a bleed and to find out if TPA is warrented. So, CT is kind of mandatory in cases with stroke symptoms even though with this case we worried about the radiation.

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Got to keep mama alive first.

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Specializes in ER/Trauma.
I'm surprised they did a CT scan first...CT imaging is more harmful to a fetus than MRI because of the radiation. In an emergency, however, I guess you do what you have to do. Hope she is ok. :redpinkhe

Got to keep mama alive first.
Yep.

Can't help baby if Mama is dead...

Besides - our pregnant mamas get a lead shield on their abdomen as an added precaution (we also place barriers over breasts when women undergo abdomen/pelvis scans to reduce exposure and reduce breast CA risk).

- Roy

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