Fatal subarachnoid haemorrhage in young women: role of oral contraceptives.

The authors discuss results of their examination of death certificates of 446 women ages 15-44 in England and Wales who were certified as dying of subarachnoid hemorrhage (SH). For a variety of reasons a number of women were eliminated from this analysis and results are based on 168 completed case control sets. Controls were matched for age marital status and social class distribution. Postmortem findings were used for diagnosis in 57% of the cases operative findings in 5% of the cases clinical findings in 31% and angiography or tomography in 8%. Current or past use of oral contraceptives (OCs) did not appear to be any different between cases and controls. Known risk factors for SH were more prevalent in cases than controls. These included hypertension preeclamptic toxemia renal disease and previous SH. A higher rate of past use (55%) was seen among those with hypertension and a lower rate of current use (9%) when compared to nonhypertensive cases. There were more smokers (61%) among the SH group than controls (32%). This study confirms the importance of known risk factors for SH. Findings from this and other studies suggest that both the relative and absolute risks of SH associated with the use of OCs are small and are probably associated with the hypertensive effect of the pill.