You meet Mandy at the antenatal clinic this morning. Mandy is 26 years old. She says that she was diagnosed with epilepsy when she was 8 years old and bar a few seizures when she was 16 years old (she says it was due to the stress of taking 8 GCSE’s) she has now been seizure free for 10 years.
A couple of weeks ago she collapsed at the local bus station and a member of the public called an ambulance. She attended Accident and Emergency at the local hospital as she had hurt her head and needed stitches. When the doctor was taking a history of events he asked about her general health and when Mandy told him about how she had been sick a few times recently and thought that was why she had “probably just fainted not had a seizure at all” he asked her if she could be pregnant and recommended a pregnancy test which was positive. Mandy was asked to make an appointment with a midwife and has attended the antenatal clinic today. She is clearly upset and angry and is completely unsure “what her dates are as she was taking the Pill and not sure how this happened.” Mandy lives alone and has not told any of her family re recent attendance at the hospital or about today’s appointment. She works in a busy graphic design studio and has not told her employer either.
Activity One
What is epilepsy?
How common is epilepsy?
Activity 2:
Review the latest MBRRACE reports and note if any maternal deaths due to epilepsy. If any did they occur in the antenatal, intrapartum or postnatal period?
Reports have highlighted that there is a lack of co ordination when caring for woman with epilepsy. Who should you involve from the MDT after you have taken Mandy’s history at today’s clinic?
Activity 3:
- Erratic taking of medications as prescribed by a doctor.
- Excessive tiredness and poor sleeping patterns.
- Stress.
- Use of alcohol and/or recreational drugs.
- Flashing or flickering lights ( often now warnings are given on TV or cinemas).
- Hormonal changes associated with periods.
- Skipping meals.
- A raised temperature.
- Illness such as flu
Noting these triggers what important advice can we give to Mandy today to help reduce any further seizures. Are there other members of the MDT/other agencies we need to include when offering advice ?
Activity 4:
What medication may Mandy be taking for control of her epilepsy?
Are there any contraindications? List these.
Are there any side effects? List these.
INTRAPARTUM CARE
Activity 5:
Mandy births a baby boy, weighing 3.5kgs at 40 weeks gestation. Doctors involved in her care had discussed the option of induction of labour at 40 weeks with Mandy as she had continued to have seizures in the antenatal period and she was happy and birthed her baby at the local Maternity hospital.
What measures can you as midwife undertake to minimise the risk of a seizure in labour and in the immediate postnatal period once Mandy was transferred to the ward?
The next morning whilst on ward Mandy is seen to be distressed, sweating and agitated and the MCA rings the emergency buzzer.
Activity 6:
Describe the management of an epileptic seizure.
POSTNATAL CARE:
Activity 7:
Are there any additional considerations to discuss with Mandy if she choose to breast feed?
What important considerations does the midwife need to discuss with Mandy re pre conceptual care for future pregnancies?
REFERENCES
Epilepsy Action UK: Mothers in mind project
Information for mothers and professionals
http://www.epilepsy.org.uk/mothersinmind