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8 Cards in this Set
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Epilepsy in pregnancy - epidemiology - complications |
90% of pregnancies are w/o complications (if epileptic), however 2-3x increase risk of malformations c/b: low birth weight, lower APGARS, pre-E, bleeding, placental abruption, prematurity |
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Preconception and Epilepsy - testing - supplements |
optimize minimal dosage or consider titrating down/discontinuation if > 2yrs w/o sz folic acid 4mg (normal dose .4-.6mg) avoid valproic acid, phenytoin (Dilantin), phenobarbital= approximately 15-20% risk of embryopathies [ cat D] screen for NTD serum AFP at 16w fetal echo or targeted US at 18-22w *no need for routine NST* consider Vit K 10-20mg po starting at 36w to prevent neonatal bleed |
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valproic acid (valproate) exposure in pregnancy
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NTD risk 1:20 in first 12w background risk is 1:1,500 |
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phenytoin (Dilantin) exposure in prengnacy
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fetal hydantoin syndrome: - hypoplasia and ossification of distal phalanges - craniofacial defects - maternal gingival hyperplasia - hirsutism - CNS, bone, and liver toxicity in mother |
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carbamazepine
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fetal craniofacial and NTD maternal side-effects: dizziness, ataxia, blurred vision, heme toxicity |
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management of status epilepticus
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- Ativan .02-.02 mg/kg IV repeat as needed - fosphenytoin 15-20mg/Kg load with maintenance of 100-150mg/minute *no magnesium sulfate!* |
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mechanism of eclamptic seizure
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Eclampsia is a form of hypertensive encephalopathy: cerebral vascular resistance is reduced, leading to increased blood flow to the brain, cerebral edema and resultant convulsions.[20] The presence of a placenta is required. Reduced blood flow to the placenta (placental hypoperfusion) is a key feature of the process. increased sensitivity of the maternal vasculature to agents which cause constriction of the small arteries, leading to reduced blood flow to multiple organs. activation of the coagulation cascade may lead to microthrombi formation, which can further impair blood flow. increased vascular permeability results in the shift of extracellular fluid from the blood to the interstitial space, with further reduction in blood flow, and edema. hypertension; renal, pulmonary, and hepatic dysfunction; and cerebral edema with cerebral dysfunction and convulsions.[16] The placenta produces the potent vasodilator adrenomedullin: it is reduced in pre-eclampsia and eclampsia.[18] Other vasodilators are also reduced, including prostacyclin, thromboxane A2, nitric oxide, and endothelins, also leading to vasoconstriction.[13] |
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migraine is pregnancy
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1.) Tylenol 1g PO 2.) Tylenol + Excedrin migraine (caffeine + ASA) *NSAIDS only for 48hours* 3.)opiods and antiemetics 4.) triptans |
