Canadian Stroke Best Practice Consensus Statement: Acute Stroke Management during pregnancy

Noor Niyar N. Ladhani; Richard H. Swartz; Norine Foley; Kara Nerenberg; Eric E. Smith; Gord Gubitz; Dariush Dowlatshahi; Jayson Potts; Joel G. Ray; Jon Barrett; Cheryl Bushnell; Simerpreet Bal; Wee Shian Chan; Radha Chari; Meryem El Amrani; Shital Gandhi; Michael D. Hill; Andra James; Thomas Jeerakathil; Albert Jin; Adam Kirton; Sylvain Lanthier; Andrea Lausman; Lisa Rae Leffert; Jennifer Mandzia; Bijoy Menon; Aleksandra Pikula; Alexandre Poppe; Gustavo Saposnik; Mukul Sharma; Sanjit Bhogal; Elisabeth Smitko; M. Patrice Lindsay

doi:10.1177/1747493018786617

Canadian Stroke Best Practice Consensus Statement: Acute Stroke Management during pregnancy

Noor Niyar N. Ladhani, Richard H. Swartz, Norine Foley, Kara Nerenberg, Eric E. Smith, Gord Gubitz, Dariush Dowlatshahi, Jayson Potts, Joel G. Ray, Jon Barrett, Cheryl Bushnell, Simerpreet Bal, Wee Shian Chan, Radha Chari, Meryem El Amrani, Shital Gandhi, Michael D. Hill, Andra James, Thomas Jeerakathil, Albert JinAdam Kirton, Sylvain Lanthier, Andrea Lausman, Lisa Rae Leffert, Jennifer Mandzia, Bijoy Menon, Aleksandra Pikula, Alexandre Poppe, Gustavo Saposnik, Mukul Sharma, Sanjit Bhogal, Elisabeth Smitko, M. Patrice Lindsay

Medicine

Research output: Contribution to journal › Article › peer-review

71 Citations (Scopus)

Abstract

The Canadian Stroke Best Practice Consensus Statement Acute Stroke Management during Pregnancy is the second of a two-part series devoted to stroke in pregnancy. The first part focused on the unique aspects of secondary stroke prevention in a woman with a prior history of stroke who is, or is planning to become, pregnant. This document focuses on the management of a woman who experiences an acute stroke during pregnancy. This consensus statement was developed in recognition of the need for a specifically tailored approach to the management of this group of patients in the absence of any broad-based, stroke-specific guidelines or consensus statements, which do not exist currently. The foundation for the development of this document was the concept that maternal health is vital for fetal well-being; therefore, management decisions should be based first on the confluence of two clinical considerations: (a) decisions that would be made if the patient wasn't pregnant and (b) decisions that would be made if the patient hadn't had a stroke, then nuanced as needed. While empirical research in this area is limited, this consensus document is based on the best available literature and guided by expert consensus. Issues addressed in this document include initial emergency management, diagnostic imaging, acute stroke treatment, the management of hemorrhagic stroke, anesthetic management, post stroke management for women with a stroke in pregnancy, intrapartum considerations, and postpartum management. These statements are appropriate for healthcare professionals across all disciplines and system planners to ensure pregnant women who experience a stroke have timely access to both expert neurological and obstetric care.

Original language	English
Pages (from-to)	743-758
Number of pages	16
Journal	International Journal of Stroke
Volume	13
Issue number	7
DOIs	https://doi.org/10.1177/1747493018786617
Publication status	Published - Oct 1 2018

Bibliographical note

Funding Information:
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The development of the Canadian Stroke Best Practice Recommendations including this consensus statement is funded in its entirety by the Heart and Stroke Foundation of Canada. No funds for the development of these guidelines come from commercial interests, including pharmaceutical and device companies. All members of the recommendation writing groups and external reviewers are volunteers and do not receive any remuneration for participation in guideline development, updates, and reviews.

Funding Information:
Heart and Stroke gratefully acknowledges the Acute Stroke in Pregnancy writing group leaders and members all of whom have volunteered their time and expertise to the update of these recommendations. Members of the Canadian Stroke Consortium were involved in all aspects of the development of these recommendations. Members of the Society of Obstetrics and Gynecology in Canada and the United States were involved in the development of the process and the writing of the consensus statement. This consensus statement underwent extensive internal review by members of Canadian Stroke Best Practices and Stroke Quality Advisory Committee, including Eric Smith, Ed Harrison, Robert Cote, Andrew Demchuk, Denyse Richardson, Alexandre Poppe, Moira Kapral, Farrell Leibovitch, Christine Papoushek, Alan Bell, Barbara Campbell, Cassie Chisholm, Hillel Finestone, Dwayne Forsman, Devin Harris, Michael Hill, Thomas Jeerakathil, Michael Kelly, Noreen Kamal, Eddy Lang, Beth Linkewich, Colleen O'Connell, Jai Shankar, Mikul Sharma, Dawn Tymianski, Katie White, and Samuel Yip. Several external reviewers conducted independent reviews and provided feedback on this consensus statement, including Dylan Blacquiere, Brian Buck, Laura Gioia, Patricia Gallagher, Trish Heim-Neima, Moira Kapral, Pascale Lavoie, Ariane Mackey, Eliza Miller, Jeyaraj Pandian, Simona Sacco, Nadine Sauv?, Amytis Towfighi, MV Padma Vasantha, and Sonia Vaida. We acknowledge and thank Norine Foley and Sanjit Bhogal and the evidence analysis team at workHORSE; the Stroke, Communications, Translation, Knowledge Exchange, Health Policy and Promote Recovery teams at the Heart and Stroke Foundation.

Publisher Copyright:
© 2018 World Stroke Organization.

ASJC Scopus Subject Areas

Neurology

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1177/1747493018786617

Cite this

Ladhani, N. N. N., Swartz, R. H., Foley, N., Nerenberg, K., Smith, E. E., Gubitz, G., Dowlatshahi, D., Potts, J., Ray, J. G., Barrett, J., Bushnell, C., Bal, S., Chan, W. S., Chari, R., El Amrani, M., Gandhi, S., Hill, M. D., James, A., Jeerakathil, T., ... Lindsay, M. P. (2018). Canadian Stroke Best Practice Consensus Statement: Acute Stroke Management during pregnancy. International Journal of Stroke, 13(7), 743-758. https://doi.org/10.1177/1747493018786617

Ladhani, NNN, Swartz, RH, Foley, N, Nerenberg, K, Smith, EE, Gubitz, G, Dowlatshahi, D, Potts, J, Ray, JG, Barrett, J, Bushnell, C, Bal, S, Chan, WS, Chari, R, El Amrani, M, Gandhi, S, Hill, MD, James, A, Jeerakathil, T, Jin, A, Kirton, A, Lanthier, S, Lausman, A, Leffert, LR, Mandzia, J, Menon, B, Pikula, A, Poppe, A, Saposnik, G, Sharma, M, Bhogal, S, Smitko, E & Lindsay, MP 2018, 'Canadian Stroke Best Practice Consensus Statement: Acute Stroke Management during pregnancy', International Journal of Stroke, vol. 13, no. 7, pp. 743-758. https://doi.org/10.1177/1747493018786617

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abstract = "The Canadian Stroke Best Practice Consensus Statement Acute Stroke Management during Pregnancy is the second of a two-part series devoted to stroke in pregnancy. The first part focused on the unique aspects of secondary stroke prevention in a woman with a prior history of stroke who is, or is planning to become, pregnant. This document focuses on the management of a woman who experiences an acute stroke during pregnancy. This consensus statement was developed in recognition of the need for a specifically tailored approach to the management of this group of patients in the absence of any broad-based, stroke-specific guidelines or consensus statements, which do not exist currently. The foundation for the development of this document was the concept that maternal health is vital for fetal well-being; therefore, management decisions should be based first on the confluence of two clinical considerations: (a) decisions that would be made if the patient wasn't pregnant and (b) decisions that would be made if the patient hadn't had a stroke, then nuanced as needed. While empirical research in this area is limited, this consensus document is based on the best available literature and guided by expert consensus. Issues addressed in this document include initial emergency management, diagnostic imaging, acute stroke treatment, the management of hemorrhagic stroke, anesthetic management, post stroke management for women with a stroke in pregnancy, intrapartum considerations, and postpartum management. These statements are appropriate for healthcare professionals across all disciplines and system planners to ensure pregnant women who experience a stroke have timely access to both expert neurological and obstetric care.",

author = "Ladhani, {Noor Niyar N.} and Swartz, {Richard H.} and Norine Foley and Kara Nerenberg and Smith, {Eric E.} and Gord Gubitz and Dariush Dowlatshahi and Jayson Potts and Ray, {Joel G.} and Jon Barrett and Cheryl Bushnell and Simerpreet Bal and Chan, {Wee Shian} and Radha Chari and {El Amrani}, Meryem and Shital Gandhi and Hill, {Michael D.} and Andra James and Thomas Jeerakathil and Albert Jin and Adam Kirton and Sylvain Lanthier and Andrea Lausman and Leffert, {Lisa Rae} and Jennifer Mandzia and Bijoy Menon and Aleksandra Pikula and Alexandre Poppe and Gustavo Saposnik and Mukul Sharma and Sanjit Bhogal and Elisabeth Smitko and Lindsay, {M. Patrice}",

note = "Funding Information: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The development of the Canadian Stroke Best Practice Recommendations including this consensus statement is funded in its entirety by the Heart and Stroke Foundation of Canada. No funds for the development of these guidelines come from commercial interests, including pharmaceutical and device companies. All members of the recommendation writing groups and external reviewers are volunteers and do not receive any remuneration for participation in guideline development, updates, and reviews. Funding Information: Heart and Stroke gratefully acknowledges the Acute Stroke in Pregnancy writing group leaders and members all of whom have volunteered their time and expertise to the update of these recommendations. Members of the Canadian Stroke Consortium were involved in all aspects of the development of these recommendations. Members of the Society of Obstetrics and Gynecology in Canada and the United States were involved in the development of the process and the writing of the consensus statement. This consensus statement underwent extensive internal review by members of Canadian Stroke Best Practices and Stroke Quality Advisory Committee, including Eric Smith, Ed Harrison, Robert Cote, Andrew Demchuk, Denyse Richardson, Alexandre Poppe, Moira Kapral, Farrell Leibovitch, Christine Papoushek, Alan Bell, Barbara Campbell, Cassie Chisholm, Hillel Finestone, Dwayne Forsman, Devin Harris, Michael Hill, Thomas Jeerakathil, Michael Kelly, Noreen Kamal, Eddy Lang, Beth Linkewich, Colleen O'Connell, Jai Shankar, Mikul Sharma, Dawn Tymianski, Katie White, and Samuel Yip. Several external reviewers conducted independent reviews and provided feedback on this consensus statement, including Dylan Blacquiere, Brian Buck, Laura Gioia, Patricia Gallagher, Trish Heim-Neima, Moira Kapral, Pascale Lavoie, Ariane Mackey, Eliza Miller, Jeyaraj Pandian, Simona Sacco, Nadine Sauv?, Amytis Towfighi, MV Padma Vasantha, and Sonia Vaida. We acknowledge and thank Norine Foley and Sanjit Bhogal and the evidence analysis team at workHORSE; the Stroke, Communications, Translation, Knowledge Exchange, Health Policy and Promote Recovery teams at the Heart and Stroke Foundation. Publisher Copyright: {\textcopyright} 2018 World Stroke Organization.",

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doi = "10.1177/1747493018786617",

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T2 - Acute Stroke Management during pregnancy

AU - Ladhani, Noor Niyar N.

AU - Swartz, Richard H.

AU - Foley, Norine

AU - Nerenberg, Kara

AU - Smith, Eric E.

AU - Gubitz, Gord

AU - Dowlatshahi, Dariush

AU - Potts, Jayson

AU - Ray, Joel G.

AU - Barrett, Jon

AU - Bushnell, Cheryl

AU - Bal, Simerpreet

AU - Chan, Wee Shian

AU - Chari, Radha

AU - El Amrani, Meryem

AU - Gandhi, Shital

AU - Hill, Michael D.

AU - James, Andra

AU - Jeerakathil, Thomas

AU - Jin, Albert

AU - Kirton, Adam

AU - Lanthier, Sylvain

AU - Lausman, Andrea

AU - Leffert, Lisa Rae

AU - Mandzia, Jennifer

AU - Menon, Bijoy

AU - Pikula, Aleksandra

AU - Poppe, Alexandre

AU - Saposnik, Gustavo

AU - Sharma, Mukul

AU - Bhogal, Sanjit

AU - Smitko, Elisabeth

AU - Lindsay, M. Patrice

N1 - Funding Information: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The development of the Canadian Stroke Best Practice Recommendations including this consensus statement is funded in its entirety by the Heart and Stroke Foundation of Canada. No funds for the development of these guidelines come from commercial interests, including pharmaceutical and device companies. All members of the recommendation writing groups and external reviewers are volunteers and do not receive any remuneration for participation in guideline development, updates, and reviews. Funding Information: Heart and Stroke gratefully acknowledges the Acute Stroke in Pregnancy writing group leaders and members all of whom have volunteered their time and expertise to the update of these recommendations. Members of the Canadian Stroke Consortium were involved in all aspects of the development of these recommendations. Members of the Society of Obstetrics and Gynecology in Canada and the United States were involved in the development of the process and the writing of the consensus statement. This consensus statement underwent extensive internal review by members of Canadian Stroke Best Practices and Stroke Quality Advisory Committee, including Eric Smith, Ed Harrison, Robert Cote, Andrew Demchuk, Denyse Richardson, Alexandre Poppe, Moira Kapral, Farrell Leibovitch, Christine Papoushek, Alan Bell, Barbara Campbell, Cassie Chisholm, Hillel Finestone, Dwayne Forsman, Devin Harris, Michael Hill, Thomas Jeerakathil, Michael Kelly, Noreen Kamal, Eddy Lang, Beth Linkewich, Colleen O'Connell, Jai Shankar, Mikul Sharma, Dawn Tymianski, Katie White, and Samuel Yip. Several external reviewers conducted independent reviews and provided feedback on this consensus statement, including Dylan Blacquiere, Brian Buck, Laura Gioia, Patricia Gallagher, Trish Heim-Neima, Moira Kapral, Pascale Lavoie, Ariane Mackey, Eliza Miller, Jeyaraj Pandian, Simona Sacco, Nadine Sauv?, Amytis Towfighi, MV Padma Vasantha, and Sonia Vaida. We acknowledge and thank Norine Foley and Sanjit Bhogal and the evidence analysis team at workHORSE; the Stroke, Communications, Translation, Knowledge Exchange, Health Policy and Promote Recovery teams at the Heart and Stroke Foundation. Publisher Copyright: © 2018 World Stroke Organization.

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Canadian Stroke Best Practice Consensus Statement: Acute Stroke Management during pregnancy

Abstract

Bibliographical note

ASJC Scopus Subject Areas

UN SDGs

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