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20.06.16

Women with epilepsy should have specialist pregnancy care – RCOG

New guidance from the Royal College of Obstetricians and Gynaecologists (RCOG) says that women with epilepsy should receive special support to minimise the risks during pregnancy.

The new guidance says that women at risk of seizures during labour should give birth in consultant-led units with facilities for one-to-one midwifery care and a special care baby unit should extra care be needed.

It also recommends that women take a higher dose of folic acid to reduce the risk of the baby developing spinal defects and are provided with support during pregnancy and after birth to reduce the risk of seizures.

Professor Alan Cameron, RCOG vice president for clinical quality, said: “Care of pregnant women with epilepsy has remained fragmented over recent years. This is the first ever national guideline on epilepsy and pregnancy and we hope it will support healthcare professionals to ensure that women receive the appropriate counselling before, during and after pregnancy and are aware of the risks to themselves and their baby and the benefits of appropriate treatment.

“Such a strategy will empower women to make informed decisions about their care during pregnancy with the support from a specialist team.”

From 2009 to 2013, 21 women died during pregnancy as a result of epilepsy, and a 2014 report from MBRRACE-UK recommended national guidance for the care of pregnant women with epilepsy.

The NHS is seeking to implement maternity care reforms after the National Maternity Review found that half of all term stillbirths had one element of care that required improvement which may have made a difference to the outcome.

The new guidance also highlights the dangers of anti-epilepsy medicines. Studies suggest that babies born to mothers who take the medicines during pregnancy are more likely to experience spina bifida, heart defects and autism.

It recommends that women should not stop taking the medicines completely, as this could worsen seizures, but should work with professionals to find the safest dose.

Louise Silverton, director for midwifery at the Royal College of Midwives, welcomed the new guidance, calling it “a valuable learning resource for both midwives and allied health professionals in caring for women with epilepsy”.

(Image c. David Jones from PA Wire)

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