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%.
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
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
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.