Epilepsy is the commonest serious neurological condition affecting pregnancy.
It is associated with a maternal mortality rate of 0.61 per 100 000 maternities.
Deaths from epilepsy have been a recurrent theme in the Confidential Enquires into Maternal Deaths Reports. Most women died when they were pregnant and the majority of cases were not referred for review by a neurologist despite a known history of epilepsy.
This retrospective audit looks at the preconception, antenatal, intra-partum and postnatal care given to a multi-ethnic cohort of 14 women booked at the Royal Free Hampstead NHS Trust between March 2011and March 2013.
Our data shows that, standard care was given to approximately 71% of these women pre-conceptually and to more than 90% in the antenatal period. However, the guidelines were followed in less than 50% of them postnatally.
It is important to note that just before our audit a maternal death occurred due to epilepsy in a patient not yet seen by the obstetric team. She belonged to a minority ethnic group, with limited English language skills and had stopped her anti-epileptic drugs (AED). These circumstances are almost identical to those mentioned in CMACE Reports. Despite repeated guidance given in these reports, high risk maternal deaths still continue to occur. We therefore, want to stress the importance of communication, use of interpreters and urgent referrals for women with epilepsy. Discontinuation of AED should be discouraged and women counselled that the benefits of the medications outweigh the risks.
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