Epilepsy in Pregnancy

Question 1

MDT approach?

Answer 1

Neurologist + Obstetrician

Question 2

Risks of:

• AEDs
• Sodium valproate

What needs to be done when deciding how their epilepsy will be managed?

Answer 2

Increased risk of neural tube defects from AEDs

Neurodevelopmental delay

Benefits vs risks

Question 3

Risks of having a GTCS during pregnancy?

Answer 3

Hypoxia
Miscarriage
Trauma due to fall

Question 4

Preconception:

How should Rx be optimised for the safety of the baby, in terms of dose?

What can be considered if they have been seizure-free for 2 yrs?

What drug needs to be prescribed 3 months before conception? Dose?

Answer 4

The lowest effective dose should be used with avoidance of polypharmacy

Consider stopping

Folic acid 5 mg

Question 5

Antenatal Care:

What if she becomes pregnant, and she is on valproate or phenytoin?

What if seizures are well controlled?

What cleaning method should be avoided due to the risk of drowning?

Why is Vit K needed in the last 4 wks of pregnancy?

Answer 5

Switch to safer AED

Stay on AED

Using a bath

Hepatic enzyme-inducing AEDs could lead to vit-k dependent clotting factors being reduced - especially in baby

Question 6

Intrapartum care:

What type of delivery is aimed for?

Where should delivery take place - home or hospital?

Is epidural anaesthesia safe for women with epilepsy?

What can be given if a seizure doesn’t resolve?

Why are seizures more common intrapartum and postpartum?

Answer 6

Vaginal delivery

Hospital

Yes

Benzodiazepines - Lorazepam, diazepam

Sleep deprivation
Reduced drug absorption
Hyperventilation

Question 7

Postnatal care:

What should be given to reduce risk of haemorrhagic disease of the newborn?

How long after birth are they discharged and why?

How can they avoid dropping the baby during a seizure?

How do you reduce the AEDs to their pre-pregnancy levels?

Answer 7

Vit K

24 hrs as a high-risk time for seizures

Changing baby on the floor - look at leaflets

Gradually, not all at once