Maternal mortality in venous sinus thrombosis

Patients with venous sinus thrombosis (CVST) present with unspecific symptoms such as headache, vision disturbances, or altered consciousness. Complications include intracerebral bleeding and/or increased intracranial pressure leading to poor neurological outcome. Besides clotting disorders, pregnancy and puerperium constitute risk factors for this rare condition.

Here we report two cases of pregnant women presenting with CVST with lethal outcome.

A 35-year-old patient (G1/P0) presented to the hospital at 24+6 weeks of gestation complaining of headache, fever and vomiting due to bacterial meningitis and pansinusitis. 24 hours after the first clinical symptoms, she developed CVST with increasing intracranial pressure and sudden brain death. The patient was kept on life support for 21 days to prolong the pregnancy. A caesarean section was performed at 28 weeks of gestation followed by an uncomplicated outcome of the infant.

A 20-year-old patient (G1/P0) came to the OB/GYN Department because of facial pain and vaginal bleeding at 10 weeks of gestation. She suffered an incomplete miscarriage requiring surgical intervention. The patient was also diagnosed with mastoiditis leading to CVST. After several neurosurgical interventions, she passed away.

Mortality data linked to CVST in pregnancy are sparse. Hence, no guidelines exist for the management of the condition in pregnant patients.

Health care providers should be aware of the increased risk of CVST in pregnant patients due to inflammatory foci in the head and neck region. Adequate antibiotic treatment and anticoagulation should be started early to minimize the risk of CVST.