ISC 2026 | Best practices for treating maternal stroke: suitable approaches and interprofessional collaboration

Best practices for treatment is going to entirely depend on the type of stroke that the patient is experiencing. And so, you know, given that there can be either thrombotic stroke versus hemorrhagic stroke is going to depend on how you treat the patient. Some things I would say is that for recognition and for evaluation, we don’t delay because of pregnancy. So you want to make sure you do the imaging right away, whether that’s a CT or an MRI, even with contrast in certain cases. If that’s going to help make the diagnosis, we definitely recommend that there’s no delay and that those patients are sent for imaging immediately. The other thing is we do use, for example, aspirin in pregnancy as a prevention strategy and as a treatment strategy. We generally tend to give lower doses, though, than typical adults. So usually, you know, the 162 milligrams is about as high as we’ll go in pregnancy, but that definitely can be given. We also use agents to thin the blood, such as Lovenox or heparin. So if those are strategies or things that are recommended, they can be used. Additionally, if you have ischemic stroke and the treatment is thrombolytic, that is okay to give in pregnancy. You’re not going to cause significant harm to the fetus. And so we don’t withhold that either. Although there can be situations, for example, if you’re considering having to do surgical intervention where thrombolytics may be a little bit more controversial. So there’s definitely a need for interprofessional collaboration or multidisciplinary care where you’re having the vascular neurologist and the maternal fetal medicine specialist or the OB-GYN talk about the plan of care quickly before administering things like thrombolytics just to make sure that it’s okay to do so in the setting of pregnancy.

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