Epilepsy is the commonest neurological disorder in pregnancy. With appropriate management there is no increase in complications. We performed a telephonic survey to find if maternity units had a policy for managing epilepsy in labour.
Material and methods We contacted the delivery suites of all consultant-led maternity units in England, Scotland and Wales to obtain details of their guideline for epilepsy in labour.
Results 190 consultant-led maternity units were contacted. Only 26 units had a policy for the management of seizures in labour. Of these, diazepam was used in 92% followed by lorazepam, midazolam and magnesium sulphate. Dose was specified in 77% with most units using intra-venous route. Women with epilepsy were booked under consultant care and birth-centres were not recommended.
Discussion Our study shows that although guidelines were in place for the management of pregnancy, 86% units lacked a clear policy for the management of epileptic seizures in labour. Labour is a high risk time with seizures occurring in 3.5% of women with epilepsy. There is insufficient evidence to support increased risk of pre-eclampsia in these women. Therefore, without a history of pre-eclampsia seizures in women with epilepsy should be treated as epileptic seizure and all maternity units should have clear guidelines to treat them. There is also lack of uniformity in managing this rare complication and there is need for the development of a green top guideline for the management of pregnancy in a woman with epilepsy.
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