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From Medicineworld.org: Seizures in Pregnancy

Ectopic pregnancy Hyperemesis OBGYN main  

Seizures in Pregnancy

There are two types of problems when we discuss about seizures in pregnancy.

  • The woman with epilepsy who becomes pregnant.
  • The woman who has her first seizure during pregnancy.

In a woman with epilepsy who becomes pregnant, there is no change in the pattern and frequency of seizures. But in 25% of the woman, the seizure frequency increases. In a large study of such epileptic women who become pregnant, there was a slight increase in the number of dead born babies and mental retardation and non febrile seizures in their offspring. In patients taking phenytoin, there is slight increase in tendency to bleed while delivery of the baby.

What is the risk in taking anticonvulsant medications in pregnancy?
Conventional antiepileptic drugs like phenytoin, carbamazepine, phenobarbital and valproate are all appropriate in pregnancy. The main problem with these drugs is the potential teratogenicity causing congenital malformations in the baby. In general, the risk of congenital defects is 2-3 percent in overall population of pregnant women - which increases to 4-5 percent in women taking anticonvulsant drugs during pregnancy. This risk is more or less with all anticonvulsant drugs. The most common congenital birth defect is cleft lip and cleft palate.

The newer anticonvulsant drugs are not advisable during pregnancy since not much experience is there with the use of these drugs. The risk of neural tube defect (spinal malformation) is greater with the usage of sodium valproate. This can be reduced by giving folate to the pregnant mothers before the pregnancy has begun. Also, the risk of congenital defect in the babies is more in mothers taking more than one anticonvulsant drug. Hence it is advisable to reduce to a single drug therapy after consultation with a neurologist. But the drugs should not be stopped abruptly during pregnancy. Of all the antiepileptic drugs, carbamazepine is a reasonably safe drug to be used in pregnancy.

Is breast feeding to the baby advisable while taking anticonvulsant medications?
Only small amount of the drug is excreted in the mother's milk. Hence breast feeding is not harmful to the baby and it should be continued. There is no side effect seen in the babies taking breastfeed in a mother who is on antiepileptic drugs.

Seizures in pregnant women (Eclampsia):
Eclampsia during the last trimester of pregnancy presents with hypertension and convulsions. The word eclampsia is derived from a Greek word meaning "flash of lightening". In majority of the cases eclampsia is preceded by features of pre-eclampsia. It is more common in first time mothers (75%).

What are the complications of eclampsia?
  • Tongue may be bitten or various injuries due to fall can occur in the mother.
  • Acute left ventricular failure and severe hypertension can occur.
  • Pneumonia, cerebral hemorrhage and high grade fever can occur in the mother.
  • Postpartum psychosis and sepsis can occur.
  • Fetal death due to prematurity or intrauterine asphyxia can occur.

What is the treatment for eclampsia?
The patient must be immediately admitted in a speciality hospital and heavily sedated with morphine or phenergan. In eclampsia, Lytic cocktail regime (chlorpromazine, phenergan and pethidine) and administration of magnesium sulphate are the favored treatment for the prevention of seizures. Usually Magnesium sulphate 10grams intramuscularly is given followed by 5 grams every 4th hourly. The treatment for pregnant women with eclampsia is to induce labour or perform caesarean section and manage the seizures with drugs.


Did you know?
The newer anticonvulsant drugs are not advisable during pregnancy since not much experience is there with the use of these drugs. The risk of neural tube defect (spinal malformation) is greater with the usage of sodium valproate. This can be reduced by giving folate to the pregnant mothers before the pregnancy has begun.

Medicineworld.org: Seizures in Pregnancy

Ectopic pregnancy| Hyperemesis gravidarum vomiting of pregnancy| Obgyn| Menopause symptoms| Pre eclampsia| Seizures in pregnancy| Spontaneous abortion miscarriage| Symptoms of pregnancy|

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