Neurological Complications among Pregnant and Post Partum Mothers in a Private Hospital, Yogyakarta, Indonesia

Resta Betaliani Wirata¹*, Dwi Nugroho Heri Saputro¹, Ika Retnaningsih²,

Naressia S. Ballena³, Kristian Setyo Widagdo⁴

1 Sekolah Tinggi Ilmu Kesehatan Bethesda Yakkum Yogyakarta, Indonesia

2 Bethesda Hospital Yogyakarta, Indonesia

3 Associate Professor School Nursing Centro Escolar University Manila

4 Kementrian Kependudukan dan Pembangunan Keluarga/BKKBN

*Correspondence: resta@stikesbethesda.ac.id

DOI: https://doi.org/10.71431/IJRPAS.2025.41201

 INTRODUCTION

Neurological complications in pregnancy and the puerperium deserve particular attention from specialists due to the worsening of the clinical picture for both the mother and the fetus. Women in pregnancy and puerperium with acute neurological symptoms represent a particularly critical category of patients whose diagnostic and therapeutic management must also consider the health of the newborn. The pathogenetic mechanism of these conditions results from the hormonal balance that is different in non-pregnant, pregnant and postpartum women. High estrogen levels stimulate the production of coagulation factors, increasing thromboembolic risk (1).

This complication encompasses conditions such as preeclampsia, eclampsia, stroke, peripheral neuropathy, HELLP syndrome (Hemolysis, Elevated Liver enzymes, and Low Platelet count), severe migraine, and other neurological disorders that may pose life-threatening risks to both the mother and the infant. Neurological complications during pregnancy and the postpartum period may arise from various factors, including hypertension, coagulation disorders, autoimmune diseases, and hormonal changes that affect nerve function. For instance, preeclampsia is one of the obstetric complications closely associated with neurological disturbances. Preeclampsia is characterized by hypertension and proteinuria which, if left untreated, may progress to eclampsia—manifested by seizures and an increased risk of stroke (2). Stroke during pregnancy or the postpartum period, whether ischemic or hemorrhagic, is frequently linked to hypertensive conditions or heightened hypercoagulability associated with pregnancy (2,3). In addition to preeclampsia and eclampsia, another condition of significant concern is HELLP syndrome, a severe form of preeclampsia that may lead to neurological complications such as hypertensive encephalopathy and cerebral edema (4,5,6).

Risk factors contributing to neurological complications in pregnant and postpartum women include a history of chronic hypertension, diabetes mellitus, coagulation disorders, obesity, unhealthy lifestyle, and pre-existing neurological diseases. Early detection through blood pressure monitoring, neurological assessment, and brain imaging (MRI, CT scan) is crucial to prevent morbidity and mortality associated with these complications. In addition, the use of pharmacological therapies that are safe for pregnancy, along with appropriate obstetric interventions, can mitigate the adverse effects of neurological complications on both the mother and the infant (2,6,7).

Pregnant and postpartum women presenting with acute neurological symptoms represent a highly critical patient category, where both diagnostic and therapeutic management must also take into account the health of the newborn. The pathogenic mechanisms underlying these conditions are influenced by hormonal balance differences among nonpregnant, pregnant, and postpartum women. Elevated estrogen levels stimulate the production of coagulation factors, thereby increasing the risk of thromboembolic events (1). Normal pregnancy is characterized by increased concentrations of coagulation factors VII, VIII, and X, von Willebrand factor, and fibrinogen, while levels of free protein S are reduced (8). At the same time, increased plasma and blood volume contribute to elevated blood pressure and the development of hypertension (9).

Elevated progesterone concentrations at the end of pregnancy tend to increase venous wall distension and the risk of small arterial vessel hemorrhage (10,11,12). Conversely, during the postpartum period, there is a decline in high estrogen levels. These hormonal changes can lead to alterations in cerebral bioelectrical activity and/or cerebral circulation, potentially resulting in seizures, transient or permanent cerebral ischemia, intraparenchymal or subarachnoid cerebral hemorrhage, and cerebral venous thrombosis. Research on neurological complications in pregnant and postpartum women remains limited in Indonesia. Most existing studies have focused on a single type of complication experienced either by pregnant or postpartum women. This study aims to analyze the types of neurological complications identified in medical records from two private hospitals in Yogyakarta between 2022 and 2024.

MATERIALS AND METHODS

This study employed a descriptive observational design with a retrospective approach using secondary data. The study population consisted of all pregnant and postpartum women who underwent examination or were admitted to private hospitals in Yogyakarta, Indonesia, due to neurological complications between 2022 and 2024. The sample was selected using a total sampling technique. Ethical approval for this study was granted by the Ethics Committee of the hospital in which the research was conducted.

RESULT AND DISCUSSION

Table 1. Characteristics of respondents based on age

Table 2. Characteristics of respondents based on obstetric history

Table 3. Neurological Conditions among Pregnant and Postpartum Women

The findings of this study demonstrate that neurological conditions occur in both pregnant and postpartum women, with varying prevalence patterns. During pregnancy, hypertension (75%), dizziness (55%), and gestational hypertension (40%) were the most common neurological-related manifestations. Conversely, in the postpartum period, hypertension (80%) and dizziness (60%) remained predominant. These results indicate that neurological symptoms are closely linked to hypertensive disorders of pregnancy.

Neurological Conditions in Pregnant Women

Hypertension was observed in 75% of pregnant participants, followed by dizziness (55%) and gestational hypertension (40%). These findings are consistent with previous studies showing that pregnancy-induced hypertension and preeclampsia are major contributors to neurological changes due to increased intracranial pressure and endothelial dysfunction (13,14). Preeclampsia (25%) and eclampsia (5%) were also present, supporting evidence that hypertensive disorders increase the risk of neurological complications such as seizures and headaches (15,16,17).

Transient neurological disorders such as Guillain–Barré Syndrome (5%) and Transient Ischemic Attack (5%) were rare, yet clinically relevant due to their association with immune modulation during pregnancy and increased coagulation states (18).

Neurological Conditions in Postpartum Women

Interestingly, gestational hypertension and preeclampsia were not reported postpartum, likely reflecting clinical improvement after delivery. However, persistent hypertension (80%) and dizziness (60%) suggest ongoing cardiovascular adaptation and possible autonomic imbalance during the postpartum phase (19,20,21). HELLP syndrome (20%) and paresthesia of the hands (20%) were only recorded postpartum. The occurrence of HELLP postpartum aligns with findings from Barton et al. (2018), who noted that approximately 30% of HELLP cases manifest after delivery, often within 48 hours. Paresthesia may be attributed to changes in peripheral nerve compression during labor or fluid redistribution after childbirth (22).

Linking Neurological Symptoms and Hypertensive Disorders

Across both periods, hypertension-related conditions (gestational hypertension, hypertension, preeclampsia, and dizziness) accounted for the majority of cases. Hypertension is a well-established risk factor for cerebrovascular complications, and the persistence of dizziness postpartum may indicate delayed recovery of neurological homeostasis (23). The absence of severe conditions such as eclampsia postpartum may be due to timely obstetric management.

Clinical Implications

The results highlight the need for continuous neurological monitoring during both pregnancy and postpartum, particularly in women with hypertensive risk factors. Early detection and management of hypertension and neurological signs could reduce the risk of severe consequences, including stroke, seizure, and progressive neurological impairment. Multidisciplinary collaboration involving obstetricians, neurologists, and public health professionals is essential.

Study Limitations and Recommendations

This study did not explore the severity or duration of symptoms, nor did it include longitudinal follow-up, which may have provided deeper insight into progression. Future research should incorporate larger sample sizes and evaluate long-term neurological outcomes, including quality of life and functional recovery.

CONCLUSION

Neurological conditions among pregnant and postpartum women are predominantly associated with hypertensive disorders. While hypertension and dizziness are common in both periods, HELLP syndrome and paresthesia present more frequently postpartum. These findings emphasize the importance of early screening and continuous monitoring of neurological symptoms during antenatal and postnatal care to prevent adverse maternal outcomes.

CONFLICT OF INTEREST

The authors declare that there is no conflict of interest regarding the publication of this manuscript.

ACKNOWLEDGEMENT

This work was financially supported by Sekolah Tinggi Ilmu Kesehatan Bethesda Yakkum Yogyakarta. The authors also acknowledge the contributions of the research team, institutional staff, and all participants involved in this study.

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