Obs teaching 3 Flashcards
What are some secondary causes of seizures?
- Surgery to the cerebral hemispheres
- Intracranial mass lesion
- Antiphospholipid syndrome
- Eclampsia
- Cerebral vein thrombosis (CVT)
- Thrombotic thrombocytopenic purpura (TTP)
- Stroke/ intracranial haemorrhage
What is the effect of pregnancy on epilepsy?
Mostly has no effect
64%: remained unchanged
17%: had an increase
16%: decrease in seizures in pregnancy
Why is the immediate post partum period high risk for exacerbation of seizure frequency?
increased stress
sleep deprivation
missed medication
anxiety
What is sudden unexplained death in epilepsy (SUDEP)?
Sudden, unexpected, nontraumatic and non-drowning death in patients with epilepsy, and excluding status epilepticus
Risk factors: uncontrolled epilepsy, women on multiple antiepileptic drugs, and early onset epilepsy
What are the effects of epilepsy on the pregnancy?
Small but significant increased risk of:
- Odds of spontaneous miscarriage OR 1.54
- Antepartum haemorrhage OR 1.49
- Hypertensive disorders OR 1.37
- Induction of labour OR 1.67
- Caesarean section OR 1.40
- Foetal growth restriction OR 3.51
- Postpartum haemorrhage OR 1.33
What is OR in statistics?
Odds ratio
What are some congenital malformations associated with antiepileptic drugs?
Neural tube defects
- Valproate (1-3.8%)
- Carbamazepine (0.51%)
Orofacial clefts
- Phenytoin, carbamazepine, phenobarbitone
Congenital heart defects
- Phenytoin, phenobarbitone and valproate
Foetal anticonvulsant syndrome
Hypospadias
What is hypospadias?
When the urethra develops on the underside of the penis
Which interventions can minimise incidence of congenital malformations with antiepileptic drugs?
- Folic acid hight dose (5 mg/day) can be used pre-conception
- Use lowest effective dose
- Change to monotherapy if possible
- Avoid teratogenic agents (particularly sodium valproate) when planning for pregnancy
Why is vitamin K given to babies born to epileptic mothers?
When the mother is taking enzyme-inducing epilepsy medication, 1mg of intramuscular vitamin K is given to prevent haemorrhagic disease of the new born
Eg. Carbamazepine, phenytoin, phenobarbital, primidone, oxcarbazepine, topiramate, esli-carbaepine
What is the clinical effect of anaemia on pregnancy?
- Maternal Morbidity and mortality
- General effect on quality of life
- Increased risk postpartum haemorrhage, blood transfusion and cardiac failure
- Puerperal sepsis
- Foetus and infant
- Low birth weight and IUGR
- Preterm labour
- ? Cognition and language development in the neonate
What are the contraindications of IV iron therapy during pregnancy?
- Decompensated liver disease
- Acute or chronic bacteraemia
- 1st trimester of pregnancy7
- Previous Hx of anaphylaxis or reaction to transfusion
What is obstetric cholestasis?
- Itchy skin
- No skin rash
- Abnormal LFT’s
Resolves after birth
What is the pathophysiology of obstetric cholestasis?
Exact cause is unknown
- Genetic: mutations affecting hepatic bile salt transport molecules, also been found in patients with progressive familial intrahepatic cholestasis
- Hormonal: Excess circulating oestrogen and/or progesterone (eg. COCP, progesterone for preterm labour)
- Environmental: more common in winter
What are the consequences of obstetric cholestasis?
- Can cause serious foetal morbidity such as; preterm birth, iatrogenic pre-term induction or foetal death
- Increased bile salts in maternal blood can cross the placenta and bile salts can precipitate in baby’s brain and cause kernicterus
