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Nick Raine-Fenning
Course Director
Joined: 27 May 2006
Posts: 1854
Location: Nottingham
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 Posted: Mon Feb 26, 2007 5:32 pm Post subject: Pre-pregnancy counselling: Epilepsy |
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You are referred a 25-year old epileptic woman for pre-pregnancy counselling who wants to conceive but is worried about the risk to her potential offspring.
What advice would you give her about the risks to the fetus? (6 marks)
How could you reduce these risks? (6 marks)
How would you modify her pregnancy plan should she conceive? (8 marks)
Please note - this question is locked at present so you can all think about it.
It will be unlocked later this week when the guys from the Essay Practice Course will provide their answers.
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"Teale Fenning Medical Education" delivering evidence-based, exam-orientated learning since 1997 |
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Abik
Century Club
Joined: 15 Jan 2007
Posts: 243
Location: Poole
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| Posted: Sun Mar 04, 2007 5:11 pm Post subject: Re: Pre-pregnancy counselling: Epilepsy |
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| Nick Raine-Fenning wrote: | You are referred a 25-year old epileptic woman for pre-pregnancy counselling who wants to conceive but is worried about the risk to her potential offspring.
What advice would you give her about the risks to the fetus? (6 marks)
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risks of disease on pregnancy
increased risk of congenital abnormalities (even if no treatment)
teratogenicity increased with all anti-epileptics, worse with poly-pharmacy
most increase risk of neural tube defects, but phenytoin = clefts, valproate = cardiac, plus dysmorphic and milder probs
risk of epilepsy in child approx 5%, more if sibling affected and more if both parents affected.
neonatal risks of withdrawal, BF advised
risks of pregnancy on disease
1/3 increase seizures, 1/3 decrease, 1/3 no change.
biggest risk around peripartum (tired in labour, stressed)
some people stop medication or don't take as worried about baby
risk of sudden death from seizures increased?
aspiration increased
How could you reduce these risks? (6 marks)
folic acid 5mg/day from 3 months before to reduce NTD
change to single therapy
change to lower dose
stop medication if free of seizures for 2 years? (risk of seizures)
not to use valproate in fertile young women?
early epidural in labour
warn friends and families
(don't marry an epileptic man!!!!!)
How would you modify her pregnancy plan should she conceive? (8 marks)
MDT management with obs who likes epilepsy
increase folic acid
lots of info - bathing and driving
detailed anomaly scan 18-20/40
routine screening
levels of drug if seizures regular as may need to increase/ or new seizure when previoulsy free
regular review
to deliver in high risk unit
aim for vaginal delivery unless increased seizures near term or resistant to treatment. early epidural considered
neonatal alert to monitor withdrawal
encourage BF (drug lower than antenatally)
risk of seizure postpartum - change nappy on floor, shallow baths
contraception - avoid POP, implant, COCP if enzyme-inducers |
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wolverine
Century Club
Joined: 16 Jan 2007
Posts: 394
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| Posted: Sun Mar 04, 2007 5:47 pm Post subject: |
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Stem 1. Haemorrhagic disease of the newborn. (add vit K if enzyme inducers after 34 weeks in the second stem)
2. Folate throughout pregnancy as increased risk of anaemia?
aFP? increased in NTDs
3. Levels to be taken only if seizures?
Shorten 2nd stage? (consider)
Very good Abs!! If I were you I had gone for a weekend skiing!
I need help with the mcqs! |
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vani s
Century Club
Joined: 20 Jan 2007
Posts: 141
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| Posted: Sun Mar 04, 2007 7:54 pm Post subject: |
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very good bubbling by Abi,
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