The prospective research of pregnancy in 45 women with epilepsy was conduct. The most common complications of pregnancy, and the epileptic process were identified. It is shown that the usage of monotherapy be retard forms of antiepileptical drugs and early diagnosis and treatment of complications of gestation in women with epilepsy permit to reduce the percentage of perinatal losses.
Actuality: Epilepsy is currently a most common neuropsychiatric disorder in the world and occurs with a frequency of about 1% of the population, 40% of patients are women of reproductive age. Up to 1% of pregnant women suffer from epilepsy. Disease is firstly recognized during pregnancy more than in 10% of cases and in the same number of women epilepsy occurs only during pregnancy [1, 2]. Most patients require long term administration of anticonvulsants.
Despite the fact that the safe carrying of a pregnancy is a very complex problem, a significant concern is the possibility of secondary defects in fetus because of receiving antiepileptic drugs which are teratogenic or can call dementia in children in the future [4,5].
All of this points to the need for an integrated approach intreatment tactics of pregnant women with epilepsy.
Patients and methods: 45 pregnant women with epilepsy were examined at the basis of the cheirdepartment and in the RSCNS (Republican Scientific Centre of Neurosurgery). Patients were divided into two groups: first group consisted of 24 patients who had pregravid preparation, the second - 21 pregnant with spontaneous pregnancies.
The study was conducted in close collaboration with neurologists. Neurologist's main objective was to achieve a drug remission of the disease. Minimum dosage of anticonvulsants was optimal monotherapy to use.
Retard forms had been recommended to avoid significant drug fluctuations in the blood (depakinchrono, finlepsin retard) [3]. In case patient had stable long-term drug remission (at least 3 years) antiepileptic treatment was gradually canceled before pregnancy. In order to prevent congenital anomalies folic acid (3-5 mg / day in 3 divided doses) was used in a time before conception and until the 18th week of gestation. Determination of the concentration of fetoplacental unit hormones: placental lactogen, progesterone, estriol, cortisol and б-fetoprotein was conducted from the end of I trimester of pregnancy and at least once per month subsequently.
Dynamic ultrasound of the fetus had been carried out in the time of recording a pregnant in 10-13, 16-18, 22 weeks to rule out fetal anomalies and further once every 4 weeks. Considering high risk of placental insufficiency, ultrasound doppler blood flow study was conducted in the uterine arteries, umbilical artery, the aorta and the middle cerebral artery of the fetus starting from the 20th week of pregnancy.
Results:
In most women of the second group a course of the epilepsy has deteriorated (66.67% of cases), while frequency of seizures in the first group has increased only in 12.3% of cases. Increased frequency of epileptic seizures in patients of the second group, occurred more frequently in the first (44.11%) and in the third trimester (31.37%).
In 2 group complicated course of pregnancy was observed in 86.67% of cases. The threat of pregnancy termination in women with epilepsy was higher than in general population, but in women with spontaneous pregnancies occurred significantly more often than in women receiving training (47.3% and 25.5%, respectively, p <0.05).
Placental insufficiency percentage was also higher in both groups as compared with population, wherein its frequency in second group was significantly higher than in the first (45.1% and 16.7% respectively, p <0.05). As a result of placental insufficiency in women with epilepsy the most frequent complicationoccurring in fetus was the chronic intrauterine hypoxia - 20.34% in the first group and 44.41% in the second.
Placental insufficiency in the second group had accompanied by a decrease in excretion of maternal serum progesterone (from 500 to 328 ng / ml), cortisol (from 695 to 232 ng / mL), estradiol (23 to 3.6 pg / ml), and cord blood serum cortisol (from 145 to 73 ng / ml), whereas in pregnant women who had pregravidal training, timely diagnosis and therapy of chronic renal failure, indicators of fetal markers were close to the physiological norm. In this connection, the adverse perinatal outcomes in the first group were observed in 7.4% of cases that is 3.6 times less than in the second group (26.64%).
Conclusions
Pregravidal conduct training is the key to a successful pregnancy and the birth of healthy offspring of women with epilepsy. The “ideal” anticonvulsant drug therapy during pregnancy at this stage is that in which a woman has got the maximum compensation of epilepsy. For early diagnosis of possible malformations and intrauterine fetal suffering of women with epilepsy screening at the correct time should be carried out, it includes the results of ultrasound, biochemical embriospecific proteins, doppler.An obstetrician-gynecologist's and epileptologist's joint management of pregnant women suffering from epilepsy, contributes to a significant reduction in the incidence of complications of pregnancy, including a favorable outcome for mother and fetus.
LITERATURE:
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