Antepartum management of WWE

Question 1

What is the optimum method and timing of screening for detection of fetal abnormalities in WWE?

Answer 1

• Early pregnancy can be an opportunity to screen for structural abnormalities.
• The fetal anomaly scan at 18+0–20+6 weeks of gestation can identify major cardiac defects in addition to neural tube defects.

Question 2

How should women taking AEDs be monitored to avoid worsening of seizures? For WWE taking AEDs, is dose escalation better than expectant management?

Answer 2

• Regular therapeutic drug monitoring or monitoring based on clinical features to adjust the AED dose
• The levels of lamotrigine are known to fall by up to 70% in pregnancy

Question 3

What are the adverse effects of AEDs in pregnancy on the mother and how can they be minimised?

Answer 3

• Healthcare professionals should be alert to signs of depression, anxiety and any neuropsychiatric
  symptoms in mothers exposed to AEDs.
• Referral to mental health team may be necessary

Question 4

What are the risks of obstetric complications in pregnant WWE, including those taking AEDs?

Answer 4

• Spontaneous miscarriage
• Antepartum haemorrhage
• Hypertensive disorders
• Induction of labour
• Caesarean section
• Preterm delivery
• Fetal growth restriction
• Postpartum haemorrhage
• Induction of labour
• Fetal growth restriction

Question 5

How should the fetus be monitored in pregnancy? What are the effects of AEDs on cardiotocography?

Answer 5

• Serial growth scans are required for detection of small-for-gestational-age babies and to plan further
  management in WWE exposed to AEDs.
• There is no role for routine antepartum fetal surveillance with cardiotocography in WWE taking AEDs