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Alice MRCOG Part 2 > Epilepsy in Pregnancy > Flashcards

Epilepsy in Pregnancy Flashcards

1
Q

What is the prevalence of epilepsy in pregnant population?

A

0.5-1%

2009-2012- 14 mat deaths due to epilepsy
SUDEP 12/14

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2
Q

How many years seizure free- no epilepsy

A

10

Childhood epilepsy- no seizures in adulthood- no epilepsy

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3
Q

Strongest RF for SUDEP

A

Uncontrolled TC seizures

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4
Q

Risk of congenital abnormalities vs risk seizures.
Which antiepileptics lowest risk of major congenital malformation?

Better than polytherapy

A

Lamotrigine or carbamazepine monoptherapy

Levatiracitam- very little evidence long term effects

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5
Q

Which abnormalities most associated with AEDS

Brains, hearts, wees, bones

A 
NTD
Heart defects
Urinary tract
Skeletal abnormalities
Cleft palate
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6
Q

Which is worst AED for abnormalities?

A

Sodium valporate

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7
Q

How to minimise risk NTDs

A

folic acid 5mg

Lowest effective dose

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8
Q

Seizures

A

2/3 no seizure in pregnancy

If seizure free 9m-1 year- 74-92% remain seizure free in pregnancy

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9
Q

Risk associated slightly mat

7

A 
Miscarriage
APH
HTN 
IOL
C-section
PTL
FGR
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10
Q

Fetal risks>

A

Serial growth scans

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11
Q

What can be used for women with high risk of seizures in labour?

A

Clobazam- long acting benzos

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12
Q

What % women have TC seizure during lab/ up to 24 hours PP?

A

1-2%

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13
Q

Management of fit

A

Lorazepam 4mg bolus

Diazepam 10-20mg rectally

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14
Q

If seizure not controlled after 5 mins

A

Consider phenytoin 10-15mg/kg

+ deliver

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15
Q

When are women at highest risk of PP seizure?

A

day 3

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16
Q

If AED dose increased during lab

A

Review day 10

17
Q

Enzyme inducing AEDS

PPOCT

A 
Phenytoin
Phenobarbital
Oxcarbazepine
Carbamazepine
Topiramate
18
Q

Non- enzyme inducing AEDS

LLSCCGP

A 
Lamotrigine
Levatiracitam
Sodium Valporate
Clonazepam
Clobazam
Gabapentin
Pregablin
19
Q

Which contraceptives and UKMEC 3 for AEDS?

A

COCP
POP

Implanon UKMEC 2
Depot 1, Novaring 2
IUS/IUD 1

20
Q

Which non enzyme inducing AED UKMEC 3 for COCP?

A

Lamotrogine

Alice MRCOG Part 2 (16 decks)

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