When an Unborn Baby Has a Stroke

Intrauterine Stroke

When a baby has a stroke prior to birth, the anxiety and uncertainty can be overwhelming for the expectant parents. In recent years, the ability of doctors to detect a stroke that affects a baby prior to birth has been improving, while scientific research on prevention and treatment has been moving forward.

Intrauterine Stroke

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Who is at Risk?
There are not usually obvious symptoms associated with intrauterine stroke (stroke of a baby before birth,) so it is important for expectant mothers to have good prenatal care and to seek urgent medical attention for health problems such as trauma, fevers and seizures.

Some pregnancies carry a higher than average possibility that the baby may experience a stroke prior to birth. More babies who experience a stroke prior to birth are born to mothers who have blood-clotting conditions than are born to mothers who do not have blood disorders. Many of these blood-clotting disorders can be identified with the use of advanced blood testing that is performed when a blood clotting or bleeding problem is suspected. Treatment of blood clotting disorders during pregnancy requires a complex decision making process. Similarly, management of a stroke that affects the baby prior to birth is not straightforward, and in some cases encompasses medication, while in other situations primarily involves observation.

What are the Consequences for the Baby?
A stroke that occurs prior to the birth of a baby results in damage to the developing brain. Given that the detection of a stroke prior to birth is only recently emerging, there were probably many instances of intrauterine stroke that were never recognized or picked up. There are a number of different possible outcomes that can result from an intrauterine stroke and they may range from mild problems to more noticeable disabilities. Some children might go on to experience seizures or cerebral palsy. Others may have weakness of one part of the body, such as the arm or leg, while some may display behavioral or learning problems, depending on which region of the brain was affected. Studies show that many children who have experienced a stroke prior to birth do not go on to have significant neurological problems in life. 

What Can You Do?
If you have a bleeding or blood-clotting problem, it is important to let your doctor know when you begin considering pregnancy or as soon as you find out that you are pregnant. Similarly, if you have suffered from recurrent miscarriages or if you have ever had blood clots, it is important to work with your health care team to determine whether you have a blood clotting or bleeding problem that you do not know about.

Taking Care of Your Baby

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If you find out, either during your pregnancy or after your baby is born, that he might have had a stroke- you need to make sure that you have a good pediatrician for your child and possibly a pediatric neurologist as well. Detailed neurological assessment in infancy can identify problems early on to help make a diagnosis, answer questions and construct a valuable plan of action. Maintaining close medical evaluation to establish and monitor the baby's neurological development is essential. Early therapy to help develop good balance and motor skills as well as emotional and learning skills can optimize recovery. Early evaluation of vision, speech and hearing can assist with directing corrective measures to help offset the disadvantage of a disability. Medication for problems such as seizures can help prevent injury and will help promote the best seizure control for the long term.

Sources:

Etiology and treatment of perinatal stroke; a role for prothrombotic coagulation factors? Cnossen MH, van Ommen CH, Appel IM, Seminars in Fetal and Neonatal Medicine, October 2009

Etiological analysis of presumed perinatal stroke, Kocaman C, Yilmaz Y, Brain and Development, February 2012

Diagnosis and acute management of perinatal arterial ischemic stroke, Armstrong-Wells J, Ferriero DM, Neurology Clinical Practice, October 2014

Perinatal stroke causes abnormal trajectory and laterality in reaching during early infancy, Chen CY, Tafone S, Lo W, Heathcock JC, Research in Developmental Disabilities, January 2015

Your Baby's Health

Expectant mothers have a lot on their plates. Knowing how to handle and recognize even the most frightening scenarios can help.

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