The confidential enquiry into maternal deaths has highlighted 14 deaths in UK due to epilepsy (0.61 per 100,000 maternities). NICE and SIGN have set out guidelines for the management of pregnant women with epilepsy.
We conducted an audit of epilepsy management during pregnancy, comparing the results with national guidance and to a previously conducted audit in the region in 2003.
All pregnant women with epilepsy booked at our medical obstetric clinic were identified, case notes obtained, and data analysed as per our objectives.
Thirty two cases were identified and 30 case notes were obtained. Only 23% had preconception counselling and 60% had pre-pregnancy folic acid. Of these, 77% had 5 mg. Specialist referral was made in 83% of cases. 82% were on antiepileptic drugs (AEDs). Of these, 56% were on monotherapy. 26% received enzyme inducing drugs and of these only 4 (50%) received 20 mg vitamin K at 36 weeks. None of them received double dose steroids. 53% experienced antenatal seizures and in 66%, seizure frequency was reduced or unchanged. Only 20% received anaesthetic review for reasons other than epilepsy. 50% were induced and 66% achieved a vaginal delivery. One fetus was found to have talipes at the anomaly scan. Postnatally only 32% received advice on infant care with epilepsy.
We propose an antenatal proforma for care of pregnant epileptic women. We also propose a postnatal information leaflet advising women on, breast feeding, infant care, importance of AEDs in the postnatal period, contraception and prepregnancy folic acid in subsequent pregnancies.
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