The 7^th Committee Meeting of Pregnancy Associated Stroke Proceedings

Abstract

Date: November 2^nd, 2018

Location: Senri Life Science Center, Osaka

Participants: Drs. Kimura, Miyamoto, Ikeda, Yamazaki, Takahashi, Otsuki, and Ohno

This committee meeting was established by four societies (JSOG, JSSHP, JNS, and JSS) in 2013. The committee acts positively to address issues, such as the following, and has yielded some results.

JSOG: Japan Society of Obstetrics and Gynecology, JSSHP: Japan Society for the Study of Hypertension in Pregnancy, JNS: Japan Neurosurgical Society, JSS: Japan Stroke Society

1 Progress status of committee activities: Mutual cooperation regarding guidelines

Japanese Guidelines for the Management of Stroke by JSS

The content of the 2015 guidelines was limited to hemorrhagic stroke. The 2021 guidelines will have a new chapter on pregnancy associated stroke (hemorrhagic and ischemic stroke). The contents of this chapter will be prepared based on discussions in this committee meeting.

Practice Guideline of Obstetrics and Gynecology by JSOG

Guideline 2017 noted, “we should treat pregnant patients with convulsion as having eclampsia”. Guideline 2020 will note, “we should treat pregnant patients with convulsion by performing a differential diagnosis of eclampsia and stroke”. The opinion of the committee was that independent CQ about pregnancy associated stroke might be necessary. The guideline committee of JSOG will discuss whether this opinion can be reflected in Guideline 2023.

Best Practice Guide for Care and Treatment of Hypertension in Pregnancy by JSSHP

JSSHP is preparing a book regarding the revision of the definition and classification of HDP in 2018. The next Best Practice Guide is scheduled to be published in 2021.

2 Progress status of committee activities: Joint symposium of the societies

The 39^th Scientific Meeting of JSSHP (2018.11.2)

Educational lecture, “Pregnancy associated stroke”, by Dr. Miyamoto

The 71^st Scientific Meeting of JSOG (2019.4.14)

Lecture, “Treatment of eclampsia and stroke during pregnancy”, by Dr. Ohno

The 78^th Scientific Meeting of JNS (2019.10.11)

A joint symposium on pregnancy associated stroke including t-PA treatment will be planned.

The 72^nd Scientific Meeting of JSOG (2020)

A joint symposium on pregnancy associated stroke will be planned.

3 Progress status of committee activities: Epidemiological nationwide survey

Nationwide survey on pregnancy associated stroke

The nationwide survey on pregnancy associated stroke by JNS and JSS has been ongoing for some time, with published articles. The next nationwide survey will be conducted by JSS 5 years after the last survey. This survey will include risk factors, special causes, and t-PA treatment strategies for stroke during pregnancy.

4 Reported matter and Agenda

Authored work

Yasumasa Ohno

“Prevention and Treatment of Stroke and Eclampsia”

Comprehensive Gynecology and Obstetrics ‘Preeclampsia’, Springer, 2018

Revision of the definition and classification of HDP (hypertensive disorders of pregnancy)

To eliminate the differences in the definition and classification of HDP between Japan and other countries, a revision was planned by JSSHP in 2018, which was approved by JSOG. The following changes have been made: 1) changed the English notation from PIH to HDP, 2) deleted eclampsia from the category and added pregnancy with essential hypertension, 3) noted that preeclampsia includes fetoplacental dysfunction, critical organ disorders, stroke, and eclampsia without proteinuria, 4) changed the border of early onset type from 32 to 34 weeks gestation.

Brain MRI screening in early pregnancy by National Cerebral and Cardiovascular Center

To prevent maternal death by stroke, a trial to enforce brain MRI at 14–16 weeks gestation has been initiated. As of June 2018, 61 pregnant women has undergone brain image screening. Abnormal findings were detected in 9, which included unruptured aneurysms in 4, pituitary adenoma in 1, subarachinoidal cyst in 1, brain tumor in 1, and white matter lesion in 2. All patients have been followed without surgical treatment.

Neurosurgeon participation in JAOG’s Maternal Death Exploratory Committee

Dr. Takahashi participates in the committee.

Enlightenment for doctors handling infertility

In recent years, the aging of pregnant women has become a global problem. There are many older infertility patients with ART. We will examine brain images of ART patients before pregnancy in cooperation with JSS.

5 Future committee activity plan

Seven members (4 obstetricians, 2 neurosurgeons, and 1 neurologist) constitute the committee. Next committee meeting is scheduled for October 11, 2019 in Osaka.