Recognizing Pregnancy-Related Strokes: Bridging the Diagnostic Gap

A University of Pittsburgh analysis finds that more than one in four pregnant or postpartum women with acute stroke had a healthcare visit for stroke-related symptoms within the prior month—missed diagnostic opportunities that likely reduced timely imaging and neurologic consultation. University of Pittsburgh analysis documents the magnitude and clinical context of those encounters.

More than 25% of cases had a prior visit for stroke-related symptoms within four weeks of the index event, underscoring the scale of missed recognition in routine care. Nearly half of those patients were evaluated by obstetric and emergency clinicians, while roughly one third had recent acute-care presentations—concentrating missed opportunities across both ambulatory and emergency settings.

Atypical symptom presentations, frequent attribution of neurologic complaints to pregnancy-related conditions such as migraine or preeclampsia, and triage workflow limitations contribute to delayed stroke diagnosis in pregnancy. The postpartum period is a window of heightened vulnerability, and presenting signs can be subtle or transient, reducing the likelihood of immediate neurologic workup. Together, these factors create predictable blind spots in which stroke may be missed.

Key Takeaways:

• University of Pittsburgh analysis documents that >25% of pregnant/postpartum stroke cases had prior missed encounters for stroke-related symptoms.
• Approximately ~50% of missed encounters involved obstetric clinicians and ~33% involved emergency clinicians.
• Priority actions include building registries, refining decision-support, and expanding interdisciplinary education to improve stroke recognition in pregnancy.