Epilepsy in pregnancy: The role of the midwife in risk management
Epilepsy is a serious neurological disease that affects approximately 1 in 200 pregnancies in the UK. Despite the majority of women with epilepsy experiencing an uneventful maternity and postnatal year, there are recurring features for those who die or experience adverse outcomes. Risk factors for morbidity and mortality in maternities with epilepsy are often determined long before pregnancy occurs. It is imperative therefore that midwives prepare for the booking appointment, conduct effective history-taking, have the knowledge to prioritise referrals, share safety advice promptly and signpost women to develop risk minimisation strategies throughout the pregnancy continuum. This article includes the use of toolkits designed to assist with this process and incorporates the latest regulatory measures for valproate medicines. Increasing midwifery knowledge about risk awareness and prevention strategies for women with epilepsy is likely to result in reduced inequalities in multi-professional healthcare provision.
Epilepsy is the most common neurological disease to be found during pregnancy, and has a significant risk of morbidity and mortality to the woman and the developing fetus (Borgelt et al, 2016; Knight et al, 2017). It is characterised by seizures, which cause a transient occurrence of signs and/or symptoms due to abnormal excessive or synchronous neuronal activity in the brain (Fisher et al, 2014). The subsequent effect of seizures and treatment prescribed to reduce these symptoms is likely to have a significant impact on health-related quality of life for those with epilepsy and their families (Michaelis et al, 2018). Personalised treatment and management is essential, and requires calculation of risks and benefits of diagnostic and therapeutic options, which are frequently readjusted throughout a person's life (Voinescu and Pennell, 2017). Prevention of seizures and optimisation of treatment therefore should be paramount in pre-conception and pregnancy planning for all women with epilepsy of childbearing potential. Despite this recommendation, maternity mortality reports in the UK have repeatedly identified a high rate of maternal death in women with epilepsy who did not receive pre-conception counselling and, subsequently, did not have the involvement of an epilepsy nurse or specialist in their pregnancy care (Kelso and Willis, 2014).
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