Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

MRCOG Part 2 > Epilepsy in Pregnancy - GT68 > Flashcards

Epilepsy in Pregnancy - GT68 Flashcards

1
Q

What is the prevalence of epilepsy in pregnancy?

A

0.5-1%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How many infant are born to women with epilepsy every year in the UK?

A

2500

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How many deaths in 2009-2012 were attributable to epilepsy in MBBRACE 2014?

A

14

12 were SUDEP - poorly controlled seizures contributing factor (tonic clonic highest risk)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

When are women no longer considered to have epilepsy?

A
  • Seizure free last 10 years (5 years off AEDs)

- Childhood epilepsy syndrome that reached adulthood seizure- and treatment-free

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Which type of epilepsy occurs more frequently after sleep deprivation?

A

Juvenile myoclonic epilepsy - sudden jerks may cause falls/dropping objects including baby

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the differential diagnoses for first seizures in pregnancy?

A
  • Eclampsia
  • Cerebral venous sinus thrombosis
  • Posterior reversible leucoencephalopathy syndrome
  • Space occupying lesions
  • Reversible cerebral vasoconstriction syndrome
  • Cardiac - Syncope 2dry to arrhythmia, aortic stenosis,
    carotid sinus sensitivity etc
  • Metabolic - hypoglycaemia, hyponatremia, Addisonian
    crisis
  • Non epileptic attack disorder
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Which AEDs have the lowest risk of congenital anomalies in the fetus?

A

Lamotrigine
Carbemazepine
monotherapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the associated congenital anomalies with sodium valproate?

A 
Neural tube defects
Facial cleft
Hypospadias
Lower IQ
Increased rates of childhood autism
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the associated congenital anomalies with phenobarbital and phenytoin?

A

Cardiac malformations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the associated congenital anomalies with phenytoin and carbemazepine?

A

Cleft palate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the generalised congenital anomalies associated with AEDs?

A

Congenital heart disorders
Neural tube defects
Urinary tract abnormalities
Skeletal abnormalities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the incidence of congenital malformations in women taking a) valproate and b) on polytherapy?

A

a) 10.7/100
b) 16.8/100

(Background 2.3%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the risk of recurrence for women with epilepsy with a previous child with a major congenital malformation?

A

16.8/100

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What % of women with epilepsy do not experience a seizure in pregnancy?

A

67%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How many women with epilepsy are estimated to discontinue AEDs when pregnant?

A

15% (may be higher with valproate)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

By how much do levels of lamotrigine fall in pregnancy?

A

70%

Routine monitoring not recommended but take individual circumstances into account

17
Q

What are the pregnancy outcomes in WWE compared to without?

A 
Spontaneous miscarriage (1.54 OR)
APH (1.49)
Hypertensive disorders (1.37)
IOL (1.67)
CS (1.40)
PTD (1.16)
FGR (1.26)
PPH (1.29)

If taking AEDs further increase in: IOL, FGR, PPH, NICU admission

18
Q

How frequent are tonic-clonic seizures in labour in women with WWE?

A

1-2%
then in a further 1-2% in the first 24 hours after delivery
Can consider clobezam (long acting benzo) if very high risk of seizures

1% of pregnant women with epilepsy status epilepticus

19
Q

How should status epilepticus (>5mins) be treated in WWE?

A

Left tilt, O2

IV lorazepam - 0.1 mg/kg (usually a 4 mg bolus, with a further dose after 10−20 minutes) or diazepam IV slowly 5-10mg

If no accesss - PR 10-20mg diazepam repeated once after 15 mins or buccal midazolam 10mg

Consider IV phenytoin if not settling; tocolytics if hypertonic and expedite delivery if FH not recovered after 5 mins

Inform neonatal team

20
Q

Which intrapartum analgesic should be avoided in WWE?

A

Pethidine - metabolised to norpethidine which is epileptogenic in high doses

21
Q

Which GA agents should be avoided in WWE?

A

Pethidine, ketamine - lower seizure threshold

Sevoflurane - epileptogenic

22
Q

How should the dose of AED be modified postnatally?

A

Usually taper down gradually to prepregnancy dose over 10/7

23
Q

What is the advice re: WWE on AEDs and breastfeeding?

A

To be encouraged - risk of adverse congenital outcome not increased

24
Q

Which contraceptives are not affected by enzyme-inducing AEDs?

A

Cu IUDs
LNG-IUS
DMPA

25
Q

Which are the enzyme-inducing AEDs and which contraceptives may be rendered less effective with their use?

A
  • Carbemazepine
  • Phenytoin
  • Phenobarbital
  • Primidone
  • Oxcarbazepine
  • Topiramate
  • Eslicarbazepine

May affect COCP, POP, Transdermal patches, vaginal ring, progesterone only implants

26
Q

Which are the non-enzyme inducing AEDs and which contraceptives can be used?

A 
Valproate
Levitiracetam
Gabapentin
Vigabatrin
Tiagabine
Pregabalin

All methods OK

27
Q

Which AED levels can be affected by oestrogen-containing contraceptives and can increase the number of seizures?

A

Lamotrigine monotherapy

MRCOG Part 2 (97 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions