According to the literature, over the past decades there has been a manifold increase in the number of pregnancies and childbirth in women with epilepsy while in 14% of women the manifestation of epilepsy occurs during pregnancy.
OBJECTIVE
To study and optimize the management of pregnancy and childbirth in women with epilepsy to improve obstetric and perinatal outcomes.
MATERIAL AND METHODS
For the period 2014—2019 performing this work the 262 pregnant women with cryptogenic epilepsy were examined and delivered. Pregnancy management and delivery were carried out at the Moscow Regional Research Institute of Obstetrics and Gynecology. Particular attention was paid to the nature of the concomitant disease, antiepileptic therapy and control over the presence of seizures. The examination included a complete standard clinical diagnostic complex, the study of hormones of the fetal-placental complex, immunological and morphological research methods.
RESULTS
Most often, the breakdown of drug remission was observed in the second trimester of pregnancy that required an increase in the dose of antiepileptic drugs (AED) or a switch to combination therapy. Patient management was carried out with the obligatory participation of a neurologist-epileptologist. Patients with obstetric complications were treated according to standard clinical protocols. Despite the presence of neurological pathology requiring constant intake of AED and pharmacological resistant form of the disease in some pregnant women, in most cases, complications of the pregnancy and childbirth were not observed. The 219 (83.5%) observed pregnant women were delivered through the vaginal birth canal. Delivery pain relief in women with epilepsy was carried out according to obstetric indications, however, with persisting convulsive seizures in the third trimester a combined method of anesthesia was used that made it possible to achieve the maximum sedative and analgesic effects. Analysis of the newborns condition showed that 89% of them were born in a satisfactory status thanks to adequate monitoring of pregnant women with epilepsy and timely correction of obstetric complications.
CONCLUSION
It has been established that for the successful completion of pregnancy in patients with epilepsy the joint observation of a pregnant obstetrician-gynecologist and a neurologist-epileptologist competent in the pregnant women epilepsy and timely correction of obstetric and neurological complications are necessary. This tactic allows the delivery of pregnant women with epilepsy mainly through the vaginal birth canal and contributes to the birth of most newborns in a satisfactory condition.
