Chapter 15 - Obstetrical Anesthesia

Summary

Epilepsy is the second most common neurological complication that will be encountered in pregnancy, exceeded only by migraine. Pregnant women with epilepsy face a number of challenges during the course of their pregnancy. They are at higher risk than the general population for maternal complications including pre-eclampsia, peripartum hemorrhage and uterine atony. There are also fetal concerns including intrauterine growth retardation and preterm delivery.[2] Some women experience increase seizure frequency during pregnancy .[3] The most important predictive factor is pre-pregnancy severity; women who remained seizure-free for at least 9 months prior to pregnancy had an 84−92% likelihood of remaining seizure-free during their pregnancy.[4] The physiologic changes in pregnancy are known to cause a drop in serum levels of anticonvulsant medications. While this occurs with all anticonvulsants, levetiracetam (Keppra) and lamotrigine (Lamictal) are particularly susceptible. Anticonvulsant levels should be obtained at the onset of pregnancy and rechecked on a regular basis with dose adjustments made to maintain a therapeutic level. Most women (nearly 90 percent) with seizure disorders will have an uneventful pregnancy with an excellent outcome.