There were 14 maternal deaths due to epilepsy reported to the 2006-08 Confidential Enquiry into Maternal Deaths in the UK. The Saving Mothers' Lives Report identifies the main factors contributing to substandard care in these deaths as a failure to refer 8 out of 14 women for neurological review, a failure both to increase lamotrigine dosage in 6 out of 9 women and to monitor levels in all women.
Our aims were to evaluate the care given preconception, during pregnancy and intrapartum to women with epilepsy in a district general hospital.
Results This was a retrospective study with data obtained from medical records. Thirty-seven women with epilepsy delivered between 01/09/2010 - 31/08/2011. Seven women were taking lamotrigine – 6 monotherapy, 1 with topiramate. No women had lamotrigine levels monitored during pregnancy nor the dosage altered. The need for folic acid supplements (5mg/day) was not documented.
Two (28.6%) women accessed preconception care – one saw a neurologist, one both obstetrician and neurologist. None of the women saw a consultant obstetrician or neurologist antenatally. Three (42.9%) women had serial ultrasound growth scans. There were no identified antenatal complications. Delivery outcomes were five normal vaginal deliveries, one instrumental, one elective section. The interaction between the combined oral contraceptive pill and lamotrigine was not documented in postnatal records.
Conclusion Our study highlights a lack of awareness of the specific considerations relating to lamotrigine treatment in pregnant women. Epilepsy is a high-risk medical condition that necessitates specialist clinical care preconception and throughout pregnancy to optimise pregnancy outcomes.
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