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Short-term Outcomes and Anesthetic Considerations in Parturients with Epilepsy: Case Series and Literature Review
Abstract Number: T3D-1
Abstract Type: Case Report/Case Series
Epilepsy and antiepileptic drug (AED) therapy put significant challenges towards maternal and neonatal health and safety. There are still inconsistent findings concerning the interaction between epilepsy, obstetric management and anesthesia considerations. This study aimed to review the efficacy of anti-epilepsy therapy, maternal and fetal outcomes.
A retrospective chart review of epilepsy cases at a large academic institution from 1995 to 2015 were conducted. Patients’ demographic data, information related to delivery, anesthesia and epilepsy, and AED medications were reviewed. Data endpoints included: delivery mode, anesthesia mode, length of hospital stay, newly onset of postpartum complications after delivery, and the therapeutic drug monitored level.
Up till the abstract submission, we have included 275 parturients with epilepsy experiencing delivery, whose age of 33.1±7.2 years, BMI of 31.2±4.9 kg/m2, gravida of 2.4± 0.7, parity of 1.1±0.6, and gestational age of 38.6±0.3 weeks. The neonatal birth weight was 3311±928 g, while the Apgar scores in 1min and 5 min were 8(8-9) and 9(9-9), respectively. There were 62 patients undergoing cesarean delivery whereas 213 cases of vaginal delivery. The average hospital stay was 3.0±1.5 days. The first onset of epilepsy was 9 (3,20) years old while duration from the last onset to delivery is 3.4(0.5-11.6) years. The data of anesthesia approaches and the main AED medication are shown in Table 1 and 2. There were 13 parturients who co-existed with depression. There were five cases of the patients who experienced relapse seizures (1.8%) in the postpartum period before discharge. Two with phenytoin levels decreasing after delivery, which was raised back in several hours, one case on carbamazepine and another case on primidone without decreasing blood level, and one without previous medication.
We found that the most common cause of the relapse of seizure was the decrease in peripartum AED blood level, which may be secondary to dilution from the large amount of IV fluid and fluid mobilization postpartum. The redistribution of AED, such as secretion from milk, may be another contributor, which does not bring worse outcomes to the neonates. The interaction between AEDs and antidepressants will be subsequently studied.
1. Yeh CC, et al. PLoS One. 2017
2. Weston J, et al. Cochrane Database Syst Rev. 2016
3. Chong DJ, et al. Curr Neurol Neurosci Rep. 2016