28 - Convulsions and epilepsy

Summary

Seizure in pregnant woman is an emergency that requires immediate actions that do not require any high-tech facilities or drugs. Generalised epileptic seizures originate within, and rapidly engage, bilaterally distributed networks. During an absence seizure a person becomes unconscious for a short amount of time, usually a few seconds. During the seizure senior staff should be summoned and the patient should not be left on her own. Vital signs including blood pressure, pulse, ECG, respiration rate, temperature, saturated O2 and fetal heart rate should be monitored. For treatment of status epilepticus lorazepam (4mg) should be administered followed by phenytoin infusion (15 mg/kg at a rate of 50 mg/min) or diazepam infusion. In resource poor settings, where most obstetrical care occurs later in pregnancy and home births are the norm, women with epilepsy, especially those with poorly controlled seizures, should be encouraged to deliver at the hospital.