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Obestetrics > Epilepsy and Migraine in pregnancy d > Flashcards

Epilepsy and Migraine in pregnancy d Flashcards

1
Q

Effect of pregancy on epilepsy

A

no consistent effect

10 fold increase mortality amongst pregnancy

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2
Q

Aim for seizure control in women w/epilepsy during pregnancy

A

minimum drug conc. req.

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3
Q

Pre-pregnancy counselling in women w/epilepsy during pregnancy

A 
Alter medication according to seizure frequency
Reduce to monotherapy if poss
Importance of adherence
Pre-conception folic acid 5mg
Risk of congential malformation
risk of recurrent seizures
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4
Q

Risk of congenital abnormality a/w epilepsy

A

2-3 fold increase due to anti-convulsant meds
Use of several AEDs further increases risk`
avoid valproate unless unresponsive to all other AEDs

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5
Q

Abnormalities a/w AEDs

A

NT defects
facial clefts
cardiac defects
Other: dev. delay, IUGR

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6
Q

Why not stop AEDs in pregnancy?

A

Risk of seizure -> hypoxia greater than risk of drug

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7
Q

breastfeeding in epilepsy?

A

encouraged

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8
Q

Causes of seizure in pregnancy

A 
Epilepsy
pre-eclampsia
Encephal/meningitis
SOL
CVA
Cerebral malaria/toxoplasma
TTP
Drug/alcohol withdrawal
Metabolic
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9
Q

Delivery in women w/epilepsy during pregnancy

A

no different from normal

epidural anaesthesia reduces stressors that may cause seizure

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10
Q

Sodium valproate in women w/epilepsy during pregnancy

A

NT defects

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11
Q

Carbamazepine in women w/epilepsy during pregnancy

A

least teratogenic of old AED

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12
Q

Phenytoin in women w/epilepsy during pregnancy

A

Cleft palate

Women receive vit K in last month of pregnancy

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13
Q

Lamotrigine in women w/epilepsy during pregnancy

A

lowest rate of congenital malformations (and levetiracetam)

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14
Q

PACES counselling of epilepsy in pregnancy

A 
Monotherapy
Congenital anomaly
Risks of epilepsy>drugs
5mg folic acid
Measures at delivery eg epidural
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15
Q

Migraine in pregnancy

A

Usually improves in pregnancy
20% of women experience migraines
Mx = analgesic and antiemetic
Low dose aspirin/beta blockers to prevent attacks

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16
Q

Summary of epilepsy in pregnancy

A 
Epilepsy risk>drugs
ALL women folic acid 5mg
Increase risk of cong. defect
Monotherapy
No indication to monitor drugs

Obestetrics (21 decks)

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