Abstracts

Rationale: Many authoritative guidelines on the treatment of epilepsy – such as the NICE clinical guidelines in the UK - include information about how best to advise or treat women of child-bearing age about the issues relating to pregnancy, epilepsy and anti-epileptic drugs (AEDs). It is likely however, that many women with epilepsy (WWE) do not have contact with specialist epilepsy services. This study aimed to determine how the care of WWE attending a general obstetric service compares to NICE guidelines.Methods: An electronic obstetric booking register was introduced to a central London hospital in July 2005. Cases with epilepsy were flagged prospectively. Consecutive bookings and notified cases were reviewed after 22 months. Demographic and clinical data were collected, including contact with neurology services in preceding 5 years. Case-notes of WWE were reviewed with respect to documentation of advice given regarding folic acid, teratogenicity, breast-feeding and mother-baby safety. These data were compared with NICE recommendations. Peri-natal details, including infant APGAR scores were recorded. WWE were contacted to obtain missing data.Results: Analysis of 7079 bookings was completed. 53 cases of WWE (prevalence 7/1000) were identified. 12 (23%) cases contained no record of date of last seizure. 32 (60%) of women had been seizure free for >12 months. Neurology follow-up had not occurred or was not described in 28 (53%) cases. 19 (36%) were on AEDs during pregnancy. 3 (6%) had stopped medication within 1 year before pregnancy. Of those taking AEDs, 6 changed doses - 4 due to changes in serum AED levels (rather than clinical events). In 10 cases (50% on those AEDs) there was no documentation of discussion about teratogenicity. In only 7 cases (13%) was use of 5mg-folic acid documented. One maternal death occurred at 30 weeks. The remainder of WWE delivered after 36 weeks. 32% underwent caesarean section (which is higher than departmental average).Conclusions: Over half of WWE booked into the obstetric service were not under neurology care despite some experiencing ongoing seizures or being on AEDs. Women who had seen a neurologist were more likely to have taken high-dose folic acid, have had dose-adjustments to AEDs before or during pregnancy, and have received advice about teratogenicity. Obstetric and foetal outcome were not significantly different to the control population, although Caesarian section rate was higher. The care of WWE attending a general obstetric service does not meet national guidelines, but this may be because guidelines are aimed at epilepsy specialists rather than those concerned with general obstetric care.