Stroke Prevention in Pregnancy and Postpartum in Patients With Patent Foramen Ovale

Pregnancy and patent foramen ovale (PFO) are both stroke risk factors in young people. There are currently no guidelines for mitigating PFO-related stroke risk during pregnancy. We summarize the pathophysiology of PFO-related stroke and offer our approaches to primary and secondary stroke prevention for pregnant patients with PFO. We present 5 clinical scenarios: incidentally identified PFO in a pregnant patient without a stroke history; considerations for PFO screening and primary stroke prevention in select patients at unusually high risk of stroke in pregnancy; planning for pregnancy after a PFO-related stroke; PFO-related stroke occurring in pregnancy; and pregnancy planning for a patient with PFO identified after a transient neurological episode of unclear cause. Through these scenarios, we highlight the unique treatment considerations and challenges of primary and secondary PFO-related stroke prevention during this high-risk period. Collaboration between neurology, cardiology, and maternal-fetal medicine is integral for the successful management of these patients.