Intrapartum care of WWE Flashcards

1
Q

What are the risks and risk factors for seizures in labour in WWE and how can they be minimised?

A
  • Adequate analgesia and appropriate care in labour should be provided to minimise risk factors for
    seizures such as insomnia, stress and dehydration.
  • Long-acting benzodiazepines such as clobazam can be considered if there is a very high risk of seizures
    in the peripartum period.
  • AED intake should be continued during labour. If this cannot be tolerated orally, a parenteral alternative should be administered.
  • Tonic-clonic seizures occur in about 1–2 % and up to 3.5 % of WWE in labour.
  • Within 24 hours of delivery in 1–2%.
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2
Q

What is the optimum management of epileptic seizures in labour?

A
  • Seizures should be terminated as soon as possible to avoid maternal and fetal hypoxia and
    fetal acidosis.
  • Benzodiazepines are the drugs of choice.
  • Continuous fetal monitoring is recommended in women at high risk of a seizure in labour, and following
    an intrapartum seizure
  • Any seizure lasting more than 5 minutes is unusual and represents a high risk of progressing to convulsive status epilepticus, which affects around 1% of pregnancies in WWE
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3
Q

Tx of seizures in labour

A
  • In those with intravenous access, lorazepam given as an intravenous dose of 0.1 mg/kg (usually a
    4 mg bolus, with a further dose after 10−20 minutes) is preferred.
  • Diazepam 5–10 mg administered slowly intravenously is an alternative.
  • If there is no intravenous access, diazepam 10−20 mg rectally repeated once 15 minutes later if there
    is a continued risk of status epilepticus, or midazolam 10 mg as a buccal preparation are suitable
  • If seizures are not controlled, consider administration of phenytoin or fosphenytoin.The loading dose of phenytoin is 10–15 mg/kg by intravenous infusion,with the usual dosage for an adult of about 1000 mg
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4
Q

Pain relief in labour

A
  • All usual stuff is ok
  • Diamorphine should be used in preference to pethidine for analgesia in labour. Pethidine is
    metabolised to norpethidine, which is known to be epileptogenic
  • If general anaesthesia becomes necessary, avoid anaesthetic agents such as pethidine, ketamine and sevoflurane.The first two are known to lower seizure threshold and the third may have epileptogenic potential.
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