Neurovascular Disorders in Pregnancy: Prevalence, Clinical Assessment and Management—A Review of the Literature

ABSTRACT Key Content Neurovascular conditions in pregnancy are rare but are associated with poor maternal and fetal outcomes. This review covers the prevalence, clinical presentation, diagnosis and management of neurovascular disorders in pregnancy. The approach to clinical assessment and investigation of pregnant women with acute or changing chronic neurovascular conditions differs from standard practice. In acute presentations where maternal prognosis is poor, standard clinical care of the underlying condition should be followed regardless of fetal compromise. Learning Objectives To understand the clinical presentation and aetiology of acute neurovascular disorders in pregnancy, and encourage early identification. To be aware of current recommendations for investigation and treatment of chronic neurovascular conditions during pregnancy. To recognise the importance of multidisciplinary care for women with acute or chronic neurovascular disorders in pregnancy. To understand the implications on future pregnancy, reproductive health and pre‐conceptual counselling. Ethical Issues Optimal management of these cases is limited by the lack of evidence. Decision making needs to balance maternal morbidity with fetal prematurity and its implications, resulting in gestational age being central to counselling women. Pre‐pregnancy counselling for chronic neurovascular conditions is complex and controversial due to a paucity of evidence.