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Chapter 13 - Obstetric and Fetal Monitoring in Women with Epilepsy

Published online by Cambridge University Press:  19 December 2024

By
John W. Snelgrove  and
Mathew Sermer
Edited by
Esther Bui  and
P. Emanuela Voinescu
Esther Bui
Affiliation:
Toronto Western Hospital
P. Emanuela Voinescu
Affiliation:
Brigham & Women's Hospital, Boston, MA
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Summary

Most women with epilepsy (WWE) will experience stable seizure control during pregnancy. Adverse fetal outcomes with epilepsy include spontaneous abortion, preterm birth, fetal growth restriction, major congenital malformation (MCM), hypertensive disorders of pregnancy, postpartum hemorrhage, peripartum depression, and—rarely—maternal death. Studies reporting these increased risks may be biased by differences in preexisting medical conditions, other patient characteristics, and anti-seizure medication (ASM) use and type. Poor seizure control preceding pregnancy, unplanned pregnancy, and polytherapy are associated with higher risks. Antenatal care should be coordinated by an experienced multidisciplinary team. Monotherapy with an appropriate ASM at the lowest effective dose is the goal, and drug levels should be monitored. Second trimester fetal anatomical sonography is the best screening modality for neural tube defects and other MCMs. Serial third trimester fetal growth ultrasounds are recommended. WWE are likely to have an uncomplicated labour and delivery. Epilepsy is not an indication for induction of labour or caesarean delivery. The risk of intrapartum seizures is 2−3%, and intractable seizures necessitating urgent delivery are rare. Attention is needed to avoid dehydration, missed ASM doses, sleep deprivation, and pain during labour and postpartum. WWE should be screened and counselled regarding their heightened risk of peripartum depression.

Keywords

epilepsypregnancyantiepileptic drugspreterm birthfetal growth restrictionpostpartum depressioncaesarean section
Type
Chapter
Information
Women with Epilepsy
A Practical Management Handbook
 , pp. 231 - 240
Publisher: Cambridge University Press
Print publication year: 2025

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