An audit of the care and outcomes of pregnant epileptic patients

Background Epilepsy in pregnancy requires multidisciplinary and specialist input. Method A retrospective audit was conducted of the care of 50 consecutive epileptic women who attended a joint obstetric/neurological antenatal clinic between May 2009 and October 2009. Audit standards were benchmarked according to the National Institute for Health and Clinical Excellence guidelines. Results The average age and parity of the women was 27 years (15–42) and P1 (1–6), respectively. 37 women had grandmal epilepsy, 11 had petit mal and 2 had juvenile myoclonic seizures. There were 5 (10%) general practitioner (GP) referrals for preconceptual counselling and 14/50 (28%) received preconceptual folic acid. 11/50(22%) required no anti-epileptic medications while 32/50 (62%) and 8/50 (16%) of women required monotherapy and polytherapy respectively. The commonest antiepileptic drug administered was lamotrigine in 36% (18/50). 19/50 (38%) experienced increased seizure frequency during pregnancy. No seizures occurred during labour. 1 (2%) patient sustained a postpartum seizure. 29/50 (58%) laboured spontaneously and 15/50 (30%) were induced (10 for obstetric reasons such as preeclamptic toxemia). 1/50 (2%) underwent a medical TOP for fetal abnormality. There were 5/50 elective caesarean sections (C/S), 8/50 emergency C/S and 36/50 (72%) vaginal deliveries. Birth-weight less than the 50th centile occurred in 30/50(60%) of patients; 66% of whom (4/6) and (2/3), were taking sodium valproate and carbamazepine respectively. There were five admissions to NICU. All babies received intramuscular vitamin K. Conclusion This audit highlights the need for improved multidisciplinary care. More referrals or conducting of preconceptual counselling by GPs themselves will enable better compliance of preconceptual folic acid and improve overall patient education.