The care of pregnant women with epilepsy--a survey of obstetricians in Scotland

Abstract

There is concern regarding the teratogenic risks of antiepileptic drugs (AEDs) and the effect of seizures during pregnancy. Pre-pregnancy assessment and collaboration with the patient's neurologist may improve outcome. This study examined by postal questionnaire how senior obstetricians in Scotland cared for their patients with epilepsy in March 1994. One hundred and nine of 127 (86%) practising obstetricians representative of those working in both teaching and district general hospitals in Scotland responded. Only 16% of district general hospital obstetricians had an accessible epilepsy clinic/service and 19% a neurologist. Only 21% of all respondents considered that pregnancy counselling was being provided by a neurologist/epilepsy specialist, and only 43% were usually able to organize combined specialist care with an interested physician/neurologist. Most (79%) were happy with the concept of collaborative care. Many were uncertain as to the importance of recording epilepsy severity, genetic aspects, making changes to AEDs, monitoring drug levels, the use of vitamin K and breast feeding. Sixty-four per cent did not change their management of labour. Twenty per cent were dissatisfied with the present care of their patients with epilepsy. Over 90% considered guidelines to be important. This survey demonstrates the need for existing epilepsy services to be more accessible to all obstetricians in Scotland, particularly for those working in district general hospitals.