Epilepsy management in pregnancy

1. EPILEPSY

2. PRE CONCEPTION:-
• Identify women planning for pregnancy/newly wed WWE
• Epilepsy register in PHC
• T.Folic acid 5mg od
• Refer To get neurologist review
• Advice to take AED regularly
• Advice to report if missed periods as early as possible
MANAGEMENT OF WWE PRIMARY CARE LEVEL

4. • Seizure frequency AEDS
• Uncontrolled seizures (particularly tonic clonic)
• Taking high doses of AEDs
• Polytherapy: multiple AEDs
• Drug resistant epilepsy/uncontrolled epilepsy
• Non-compliance with medication
• General health
• Poor general health
• Other medical comorbidities
WHEN TO AVOID/POSTPONE PREGNANCY

5. • T.Folic acid 5mg od throughout pregnancy
• Advise NOT to discontinue AED
• Refer to tertiary care centre for neurologist opinion
• Educate about seizure triggering factors and advise to avoid them.
TRIGGERS:-
• Missed medication
• Sleep deprivation
• Emotional and physical stress
• Infections
• Low blood sugar
• Dehydration
• Alcohol/illicit drug use
• Exposure to bright light
DURING WWE ANC REGISTRATION

6. • Ensure AED compliance
• Assess seizure frequency
• Refer for anomaly scan at 18 to 20 weeks
• Fetal echo at 24 weeks
• Growth scan every 3 weeks from 28 weeks
• Ensure iron and folic acid intake
• Check Hb regularly and Correct anemia
• Neurologist review every trimester
• Refer to tertiary care center at any time seizure occurs after stabilizing the pt
• Plan for delivery at tertiary care center
• Refer 15days before EDD for delivery

7. TREATMENT OF SEIZURES -PRIMARY LEVEL
• Call for help
• Put the patient to left lateral position
• Secure airway
• Two IV lifelines
• Immediately start inj.MGSO4 loading dose
• Suction
• O2 by mask
• Check vitals(BP, SPO2, pulse rate, CBG)
• Catheterise the patient
• Refer to higher center

8. Early labour
• Ensure intake of AED
• Inj phenytoin 100mg iv stat and refer the pt
Active labour
• Monitor vitals and FHR
• Maintain partograph
• Inj phenytoin 100mg iv stat
• Conduct delivery
• Refer the pt after delivery to tertiary care
POSTNATAL FOLLOW UP
• Post natal visit every week to Ensure Drug compliance
• Look for and Correct anemia
• Advise to Avoid triggering factors
WWE IN LABOUR

9. TREATMENT AT SECONDARY AND TERTIARY
LEVEL

10. FLOWCHART FOR
MANAGING WOMEN WITH
EPILEPSY
TDM-Therapeutic drug
monitoring

11. • Obstetrician (specialist interest in epilepsy and/or maternal medicine trained)
• Neurologist (with working knowledge of the care and management of pregnant women with
epilepsy)
• General Physician
• Anaesthetist
• Midwife
• Epilepsy nurse specialist should integrate into routine antenatal service
MULTIDISCIPLINARY APPROACH