FEATURES OF THE COURSE OF PREGNANCY AND CHILDBIRTH IN WOMEN WITH EPILEPSY

FEATURES OF THE COURSE OF PREGNANCY AND CHILDBIRTH IN WOMEN WITH EPILEPSY

Sitora Khaydarova

Student, Tashkent Medical Academy,

Uzbekistan, Tashkent

Farrukh Saidvaliyev

Professor, Tashkent Medical Academy,

Uzbekistan, Tashkent

Gulnora Rakhimbaeva

Professor, Tashkent Medical Academy,

Uzbekistan, Tashkent

ABSTRACT

Only the partnership of a neurologist, an obstetrician-gynecologist, and the woman herself can achieve the most favorable course and outcome of pregnancy. The purpose of the study is to study the characteristics of the course of pregnancy and childbirth in women with epilepsy and to conduct a comparative analysis of the course of pregnancy and childbirth in women with epilepsy with a planned and unplanned pregnancy and healthy women in labor. The work was carried out in the departments of neurology and obstetrics and gynecology of the Tashkent Medical Academy. Under observation were 60 pregnant women with various forms of epilepsy, disease duration from 1 to 25 years, as well as 20 practically healthy pregnant women and their offspring. Recruitment to the main group was carried out as the pregnant women were admitted to the hospital. The age of pregnant women with epilepsy ranged from 17 to 40 years and averaged 25.7±5.3 years. It seemed interesting to us to analyze the change in the frequency of epileptic seizures in 9 (23.7%) pregnant women on monotherapy in the dynamics of pregnancy. Thus, in 29 (76.3%) patients, drug remission of the disease occurred. In 9 (23.7%) women, single partial seizures were noted with an increase in them in 15.8% during pregnancy and a subsequent decrease in the postpartum period to 10%.

Keywords: epilepsy, pregnancy, EEG, newborn.

Background. The relevance of the problem of pregnancy in women with epilepsy is beyond doubt due to the widespread prevalence of the disease, severe social and economic stigmatization not only for the patient and his relatives but also for society as a whole. The decision to become pregnant is made by the future parents. However, only the partnership of a neurologist, an obstetrician-gynecologist, and the woman herself can achieve the most favorable course and outcome of pregnancy. It is known that the incidence of epilepsy in the population is 1%, of which 25-40% are women of childbearing age. About 1% of pregnant women suffer from epilepsy; among them, 13% of the onset of the disease occurs during pregnancy, and in 14% of cases, seizures are observed exclusively during pregnancy (“gestational epilepsy”) (Delgado Escueta A, Janz D, 1992, Yerby MD991). Recent studies have revealed a 3-fold increase in the risk of inheriting epilepsy in a child whose mother suffers from this disease (Rakhimbaeva G.S). There is a high risk of developing a life-threatening condition such as status epilepticus during pregnancy (The EURAP Study Group, 2006). In practice, the range of issues that an obstetrician-gynecologist has to solve during pregnancy in patients with epilepsy is extremely wide: what will be the mutual influence of epilepsy and pregnancy: features of pregnancy and childbirth; teratogenic effect of antiepileptic drugs; prognosis for the birth of a healthy child, the possibility of breastfeeding while taking antiepileptic drugs, and others. These problems confirm the high importance of issues for practical medicine and require further study.

Purpose of the study: Based on the foregoing, the purpose of the study is to study the characteristics of the course of pregnancy and childbirth in women with epilepsy and to conduct a comparative analysis of the course of pregnancy and childbirth in women with epilepsy with a planned and unplanned pregnancy and healthy women in labor. To study the features of the course of pregnancy, childbirth, the postpartum period in women with epilepsy, depending on the schemes for the use of AED.

Material and methods of research: The work was carried out in the departments of neurology and obstetrics and gynecology of the Tashkent Medical Academy. Under observation were 60 pregnant women with various forms of epilepsy, disease duration from 1 to 25 years, as well as 20 practically healthy pregnant women and their offspring. Recruitment to the main group was carried out as the pregnant women were admitted to the hospital. The age of pregnant women with epilepsy ranged from 17 to 40 years and averaged 25.7±5.3 years.

Results. In the anamnesis of patients, in addition to childhood infections, there are neuro infections: influenza - in 25 (31.25%), meningoencephalitis - in 3 (3.75%), purulent otitis media - in 5 (6.25%), chronic tonsillitis - in 16 (20%) women. Traumatic brain injury of varying severity was detected in 30 (37.5%) patients, pathology of the perinatal period (asphyxia, vacuum extractor, birth injuries) - in 8 (10%) patients, febrile convulsions - in 7 (8.75 %) of patients. This pregnancy in 17 (21.25%) women is planned, in the rest - not. 12 (15%) patients were registered in the PND. Of the bad habits, smoking was noted before pregnancy and during pregnancy (49 women - 61.25%). Burdened heredity for epilepsy occurred in 5 (6.25%) women. Childbirth was the first in 57 (71.25%) women, repeated in 23 (28.75%) women. In 72 (90%) cases, delivery occurred on time, premature - 7 (8.7%), late - 1 (1.3%). Most of the primiparas with epilepsy were between 17 and 29 years of age, and only in two cases were between 30 and 34 years of age. Most of the multiparous were between the ages of 20 and 40.

In pregnant women of the control group (healthy), the average age was 29±1.5 years. Of these, 25 women (62.5%) had a permanent job, 15 (37.5%) were housewives. Burdened in heredity for epilepsy is not revealed. Of the transferred diseases, rubella, chickenpox, SARS, mumps are often noted. 22 (55%) women from this group are multiparous, 18 (45%) are primiparous. Examination of pregnant women was carried out according to the generally accepted method: we studied the general, obstetric and neurological anamnesis. We performed general and special obstetric examinations. Neurological status was assessed syndromologically. An electroencephalographic study was performed in all patients at the initial examination and later on when evaluating the efficacy of antiepileptic treatment. EEG analysis was carried out by the "electroencephalogram description and classification system" with the allocation of five types of EEG. Analysis of the course of epileptic seizures in 9 (23.7%) patients shows that, as a rule, they had an increase in seizures with a deterioration in their general condition. It seemed interesting to us to analyze the change in the frequency of epileptic seizures in 9 (23.7%) pregnant women on monotherapy in the dynamics of pregnancy. Thus, in 29 (76.3%) patients, drug remission of the disease occurred. In 9 (23.7%) women, single partial seizures were noted with an increase in them in 15.8% during pregnancy and a subsequent decrease in the postpartum period to 10%. One of the main methods of examination of patients with epilepsy is electroencephalography (EEG). All observed pregnant women underwent an electroencephalographic examination. As a result, it was found that in this group of subjects there were mild diffuse changes in the bioelectrical activity of the brain with signs of dysfunction of the median stem structures without epileptiform activity in the background recording and during functional loads were observed in 19 (50%) pregnant women; slight diffuse changes in the bioelectrical activity of the brain with signs of dysfunction of the median stem structures and generalized epileptiform activity in the background recording and during functional loads were observed in 10 (26.3%) pregnant women; moderate changes in the bioelectrical activity of the brain with signs of dysfunction of the midline structures and a focus of pathological (epileptiform) activity — in 9 (23.7%) pregnant women (Figure 2). In this study group, 19 (50%) women received valproic acid preparations and 19 (50%) received carbamazepine during pregnancy and in the postpartum period. It can be considered that the use of monotherapy in our group of pregnant women with epilepsy using carbamazepine and valproic acid preparations may have prevented the development of congenital malformations in children from this contingent of women. According to the results of our study, in the analyzed subgroups, the dosage of carbamazepine did not change during pregnancy. The concentrations of carbamazepine throughout pregnancy were relatively stable with some decrease in the level in the first and third trimesters of pregnancy. Based on the above facts about the relative stability of free concentrations of carbamazepine, in most cases throughout pregnancy, it is recommended not to change the daily dose of carbamazepine. 19 (50%) pregnant women in the dynamics of pregnancy received valproic acid preparations in the form of "Depakine" (10 - 52.6% of pregnant women) and "Convulex" (9 - 47.4% of pregnant women). According to the results of our study, it is obvious that the use of carbamazepine at doses of more than 10 mg/kg.day and valproic acid at a dose of not more than 15 mg/kg.day during pregnancy maintains the level of drugs in the blood within the conditionally therapeutic range, while 76% provide seizure control and does not exclude the possibility of using individually lower dosages of the drug due to their teratogenic effect, according to many authors. Therefore, in pregnant women with epilepsy, it is necessary to carry out sparing monotherapy with anticonvulsants under the obligatory control of the concentration of drugs in the blood serum in the dynamics of pregnancy. Analysis of the frequency of pathological abnormalities in the fetus and newborn, depending on the therapy received, revealed a significant increase in malformation (p<0.001) in the 2nd study group 80 women in the labor of the 1st and 2nd studied groups with epilepsy, observed by us, gave birth to 80 children. Of these, 72 were full-term, 8 (10%) were premature. Developmental anomalies occurred in three newborns (7.1%) of the 2nd study group, there were no deformities in the first and control groups (p<0.001).

Diagram 1. 80 observed women in 2^nd study group

At the same time, the nature of deformity in epilepsy is not uniform: in one case, a cleft lip and hard palate, in the second case, a congenital heart disease (septal defect), and in the third case, a diaphragmatic hernia. Thus, the proportion of developmental anomalies in children from mothers with epilepsy receiving polytherapy was 7.1%, in the absence of developmental anomalies in the offspring of the first study group.

Conclusion: It can be concluded that it is preferable to manage pregnant women with epilepsy on monotherapy, despite the teratogenic effect of all drugs. Dynamic joint monitoring by a neurologist and an obstetrician-gynecologist using the entire range of non-invasive methods for monitoring the course of pregnancy helps prevent adverse pregnancy outcomes.

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