Epidemiology of Pregnancy- Associated Cerebral Venous Thrombosis (CVT) in Three Referral Hospitals in Khartoum, Sudan

Abstract

Introduction Pregnancy induces several changes in the coagulation system, which persists into the puerperium resulting in a pro-thrombotic state. Cerebral venous thrombosis (CVST), has variable clinical presentations that can easily be misinterpreted with other neurological and obstetrical conditions such as eclampsia and epilepsy. Methods This is a case-control hospital-based study conducted from 1 January 2011 to 31 December 2012 to investigate the epidemiology of CVST during pregnancy and puerperium in three main referral hospitals in Khartoum, Sudan. The different variables were compared between women with confirmed CVST and two consecutive women who delivered in the hospitals without CVST using logistic regression analysis. Results During the study period there were 31 patients with radiologically confirmed CVST. These hospitals had 37 471 deliveries annually, yielding an incidence rate of 0.01 per 100 000 deliveries. Among these 31 patients, 25 (80.6%) and 6 (19.4%) were identified during the postnatal and antenatal periods, respectively. The most common presenting symptoms were headache (77.4%) followed by convulsions (74.2%), neck pain (39%), neck stiffness (32.2%), limb weakness (29%), loss of consciousness (29%), impaired vision (25.8%), and cranial nerve symptoms (22.5%). Some patients may have more than symptoms. Initially, 25.8% of patients were misdiagnosed and mistreated as cases of eclampsia. Concerning risk factors, there was significant association between age (95% CI 1.0-1.2, OR 1.1, P = 0.024), mode of delivery (95% CI 3.8-58, OR 14.9, P = 0.000), anaemia (95% CI 1.0-26.1, OR 5.2, P = 0.041) and pre-eclampsia (95% CI 1.1-89.5, OR= 10, P = 0.039) with favourable outcome of CVST cases during pregnancy and puerperium. Conclusion CVST presenting with extremely varied symptoms can simply be mistaken for eclampsia, epilepsy and other neurological diseases. Caesarean delivery, older age, anaemia and pre-eclampsia are the dominant risk factors for pregnancy-associated CVST.