Abstracts

Older literature reports that women with epilepsy (WWE) have significantly increased risk of obstetric complications such as placental insufficiency, pre-eclampsia, induced labor, low birth weight, and Cesarean section. This project examines retrospective data on obstetric complications in WWE in a large teaching hospital. We hypothesize that, with improved prenatal care, including counseling and routine folic acid supplementation, as well as the use of newer antiepileptic medications, obstetric complications in WWE are lower than suggested by previous studies. Using a patient registry database consisting of all discharges, women coded for delivery and epilepsy or seizures for the year 2000 were identified. Cases were independently verified against an obstetric database, and the following data obtained from computer generated notes, operative reports, discharge reports, and laboratory values: obstetric history; seizure type and frequency, type and duration of epilepsy, antiepileptic drug use during pregnancy, and seizures during the peripartum period; mode of delivery, gestational age, and placental abnormalities; and neonatal data including Apgar scores and major congenital malformations. Data on miscarriages was unobtainable. We identified 42 women with epilepsy or seizures who delivered at our tertiary care hospital. In accordance with expected population numbers, these (n=42) represent approximately 0.4% of the total number of women ([sim]10,000) who deliver at this hospital per year. Of the 42 records obtained, 35 were available for review. Three patients had eclamptic seizures, and were eliminated from further analysis. Almost two thirds of WWE were on AEDs at the time of delivery. Six of the remaining 32 patients (19%) had failure to progress during delivery, and no women (other than the eclamptic patients) had a seizure during delivery or the immediate post-partum period. Three patients (9%) had preterm delivery, and fourteen (44%) had Cesarean section. Placental abnormalities did not occur in these 32 women. One patient (2.8%) was transferred for delivery of a child with a known congenital malformation. Our facility has a large number of referrals for high risk and complicated pregnancies. Results demonstrated a rate of congenital malformations similar to that seen in the general population, but there was a suggestion of higher than expected rates of preterm delivery, failure to progress, and Cesarean section. (Supported by Departmental funds.)