Epilepsy in Pregnancy Flashcards
1
Q
Epidemiology
A
- 1/3 of pregnant women with epilepsy will have an increase in seizure frequency
- 90% have no complications
- A first seizure in the second half of pregnancy is eclampsia until proven otherwise
2
Q
Teratogenicity of sodium valproate
A
- Neurocognitive impairment
- Autistic spectrum disorders
- Attention deficit disorders
- Neural tube defects
- Hypospadias
- Heart defects
- Craniofacial anomalies
- Skeletal anomalies
- Developmental delay
3
Q
Folic acid use in epileptic pregnancies
A
- Anti-epileptic drugsreduce the availability of serum folate
- Advise 5mg/day for at least 1 month prior to conception
- Even if no AED higher risk of NTDs with maternal epilepsy
4
Q
Vitamin K in epileptic pregnancies
A
- AEDs induce fetal hepatic enzyme activity which lowers vitamin K and causes neonatal bleeding
5
Q
Effect of pregnancy on epilepsy
A
- Seizure activity changes variable
- Reduced medication compliance
- Reduced absorption (N&V)
- Impaired sleep
- Reduced drug levels (increased volume of distrubution and metabolism)
6
Q
Management of epilepsy in pregnancy
A
7
Q
Antenatal management
A
- Therapeutic drug monitoring
- Screening for birth defects
- 11-13 weeks - acrania, nuchal
- 20 weeks - NTD, heart, face, limbs
- +/- serum screening
- Advice on bathing
8
Q
Intrapartum management
A
- IV access
- Continue AEDs at normal time
- Avoid maternal exhaustion
- CTG monitoring - tonic cloinic associated with hypoxia
- Benzodiazepines for seizure termination
9
Q
Post-natal care
A
- Plasma levels fluctuate for 8 weeks so require dose
- Most safe to breastfeed
- Contraceptive options
- Copper IUDs and medroxyprogesterone acetate most effective
- Risk of failure with hormonal contraceptives
