Anticonvulsants in Pregnancy Flashcards
1
Q
A young epileptic woman on anticonvulsant therapy wishes to have a baby. What are the important issues that need to be discussed with her?
A
Impression
This woman needs counselling for managing her epilepsy in preparation for falling pregnant.
Key points to cover;
- pre-conception
- intra-partum
- delivery
- post-partum care
Take Hx/Ex/Ix to further understand the woman situation, to provide situation-specific counselling and information
2
Q
AEDs in pregnancy - History
A
History
- PC: details of epilepsy, how regular seizures, what is current therapy, level of current control, dosage
- RISKS: compliance, sleep deprivation, stress, anxiety, exposure to triggers
- O&G history
3
Q
AEDs in pregnancy - Ex/Ix
A
Ex/Ix
- general obs + vitals
- anthropometric
Ix
- serum level of AED
4
Q
AEDs in pregnancy - pre-conception
A
Pre-conception
- majority of women with epilepsy have good pregnancy outcomes. 95% deliver normally
- increased risk of congenital malformations whilst on AEDs
- need to avoid valproate: either switch now to other anti epileptic or not start it (may need to be in discussion with neurologist) - balance risks and benefits
- aim for the lowest effective does of AED
- ensure effective contraception until good seizure control is achieved, aim 6-months of seizure control before conception
- high dose of folic acid supplementation for at least 1 month before conception
5
Q
AEDs in pregnancy - Intrapartum and delivery
A
Intrapartum
- supportive, regular monitoring during pregnancy
- AED level altered by vomiting, may need to adjust
- avoid seizure triggers
Delivery
- increased risk of seizure during labour
- avoid triggers
- terminate any seizure activity with benzodiazepines
6
Q
AEDs in pregnancy - Post-partum care
A
Post-partum
- referral to neurology
- AEDs excreted in breast ilk - weigh up pro’s and cons of breast-milk vs bottle feeding
- discuss contraception again
