Abstracts

To provide a clinic and advisory service for pregnant women with epilepsy and to evaluate the care received by such women with regard to their epilepsy and antiepileptic drug therapy during pregnancy. Arising out of our successful Preconception Clinic for women with epilepsy (Betts T and Fox C. Seizure 1999;8:322-327) we have set up a formal clinic for women with epilepsy who are pregnant. Some come from our continuing preconception clinic but an increasing number previously unknown to us are referred already pregnant by General Practitioners. In addition we provide an advisory service for other Birmingham maternity clinics and beyond. We have seen nearly 200 pregnant women in the 2 years the clinic has been open. Our early experience is that few women with epilepsy (unless they attend our preconception clinic) enter pregnancy in a planned way. Some are taking sodium valproate without any information about its pregnancy risks; nearly 30% turn out not to have epilepsy despite taking anticonvulsants; very few are taking an appropriate dose of folic acid. Our elective Caesarian section rate is less than 5% and we try to keep labour to 12 hours or less but recognise that we need to improve epilepsy education for obstetric doctors and midwives if birth plans are to remain intact. Our early impression is that premature birth is more common in women with epilepsy as may be foetal loss in the early puerperium and we have set up a controlled comparison to evaluate this. The one maternal death appears to have been a sudden death in epilepsy.