QuestionSBA
QuestionChoice
Long-acting benzodiazepines such as clobazam may be considered in high-risk epileptics such as those who have had recent seizures, have a history of seizure provocation by stress or sleep deprivation, or have suffered seizures in a previous labour.
50005
d
Oral clobazam 20mg daily
QuestionChoice
Intravenous lorazepam is used to treat seizures, and would not be an appropriate routine part of labour management.
50003
b
Intravenous lorazepam at a dose of 0.1 mg/kg
QuestionChoice
Intramuscular vitamin K should be administered to all babies born to women with epilepsy to prevent haemorrhagic disease of the newborn. It should not be adminstered to the mother.
50006
e
Intramuscular vitamin K, 1 mg
QuestionChoice
Women should continue taking their regular anti-epileptic drugs orally during labour where tolerated.
50002
a
Oral Levetiracetam 500mg twice daily
QuestionChoice
Intravenous therapy may be used where oral therapy is not tolerated in labour. There is no indication in this stem that the patient is unable to take her regular medication.
50004
c
Intravenous Levetiracetam 500mg twice daily
QuestionComment
what a random question
24236
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NICU Fever
QuestionComment
Ok I checked RCOG guidelines for intrapartum care
If LOW RISK of seizures, continue regular medications, switching to IV instead of oral only if the oral route becomes intolerable or insufficient (Vomiting for example)
If high risk of seizures, or not well controlled, give Clobazam intrapartum
The baby, NOT THE MOTHER, gets Vit K postpartum
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moins que
QuestionComment
How do you know what is considered high risk and low risk 
48647
QuestionComment
I think as seizure free throughout pregnancy
49143
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Thermoregulator Relapse
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Edema Dominant
Concept
Chapter
# Management of epilepsy in pregnancy (pre-pregnancy)



- Neurology review should be sought to assess existing anti-epileptic medication and aim for monotherapy (single drug regime). The lowest effective dose of the medication should be used.
- Levetiracetam and lamotrigine are the safest anti-epileptic medications to use during pregnancy. Sodium valproate should be avoided in pregnancy as it carries the highest risk of congenital defects.
- In general women with history of epilepsy but with no high risk of unprovoked seizures can be managed as low risk pregnancies and if no fits have occurred for at least 2 years consider stopping all medication.
- Drug compliance must be emphasised and the woman should be advised to continue her medication through pregnancy.
- All need to take 5mg/day of folic acid pre-conceptually until at least the end of the first trimester. This is to minimise the risk of neural tube defects and folate deficiency.

# Management of epilepsy in pregnancy (Antenatal)

- All pregnant women with epilepsy should be under joint medical and obstetric care.
- Plasma anti-epileptic drugs levels should be monitored regularly, as levels are likely to decrease with increasing plasma volume during pregnancy.
- The foetus should be monitored throughout pregnancy for abnormalities with serial growth and anomaly scans.
- Anti-epileptic regimes may inhibit foetal clotting factor production so vitamin K therapy should be given from 36 weeks gestation.
- Pregnant women with epilepsy should be reassured that most will have an uncomplicated labour and delivery and that there are no specific differences in labour management compared to non-epileptic women.
- If epileptic seizures do occur during labour, they should be terminated as quickly as possible with benzodiazepines in order to avoid maternal and foetal hypoxia.
- Note that if a pregnant women with no previous diagnosis of epilepsy presents after the first trimester with seizures, the immediate management guidelines for eclampsia should be followed until a definitive neurological diagnosis can be made.

# Management of epilepsy in pregnancy (Postnatal management)

- It is generally safe to take anti-epileptic drugs whilst breastfeeding.
- The anti-epileptic doses should be reviewed after delivery to prevent postpartum toxicity as plasma levels return to normal.
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Epilepsy in pregnancy
Topic
38
Obstetrics
Video
Concept
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Epilepsy in pregnancy
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Epilepsy syndromes
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A 22-year-old woman attends the maternity unit in established labour. She has a past medical history of epilepsy, and has been seizure-free throughout pregnancy on a stable dose of 500mg levetiracetam twice daily.

Which of the following is likely to be administered to her as part of her labour management?
a