Pregnancy associated Stroke

Pregnancy-associated stroke (is an uncommon condition affecting 0.02% pregnant patients. It is an important condition as maternal death from stroke occurs in 7.7% of cases. In contrast to nonpregnant women, in whom 87% of strokes are ischemic, the frequency of ischemic stroke was much lower for ischemic stroke (43%) with higher frequencies of intracranial haemorrhage (41.9%) and cerebral venous sinus thrombosis (CVT) (17.4%). Hypertensive disorder of pregnancy and low socioeconomic group are common thread linking these different causes of pregnancy associated stroke. Related to this are patients who have infertility treatment and whether having such therapy put them at risk of subsequent stroke. A brief summary of the topic can be found at https://n.neurology.org/content/99/15/639. In the acute phase of stroke, the management include reperfusion therapy or antithrombotic drug depending on the severity of stroke. Patients with TIA or minor stroke are best treated with dual antiplatelet therapy https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2818750. However, pregnant patients are excluded from stroke trials. As such it is not certain if the current trial findings apply to these patients. We will seek to perform metaanalysis of available observation studies to evaluate findings from observation studies, The optimal management of young women of childbearing age following stroke is not known. Patients will want to know if the risk of pregnancy complications (miscarriage, preterm birth, hypertensive disorder of pregnancy, gestational diabetes and recurrent stroke) are increased after prior stroke and if they can have normal delivery or will be required to have Caeserian section. This uncertainty makes it hard to advise patients on the best course of action. To evaluate our experience at Monash Health, we will perform an audit of pregnancy-associated stroke over 10 years. The student will learn statistical methods for analysing this dataset. There will be opportunities to collaborate with international researchers on this topic. This project is suitable for Medical students or Physician (doctor) trainees.