دانلود رایگان مقاله انگلیسی تشنج در بارداری- الزویر 2018

INTRODUCTION:

BACKGROUND AND EPIDEMIOLOGY Seizures are the most common major neurologic complication encountered in pregnancy with a prevalence of in the United States of 1.2%.1 Nearly one-half million women with epilepsy are of reproductive age and between 0.5% and 1.0% of all pregnancies occur among women with epilepsy.2,3 The etiology of seizures covers a wide range of diseases, vascular insults, infectious sequelae, malignant processes, metabolic derangements, toxic insults, primary central nervous system dysfunction, and more.4,5 In pregnancy, eclampsia represents a unique consideration among possible causes of seizure. Although epileptic seizures are the most common, it is crucial to accurately determine the underlying cause of seizures in pregnancy to provide appropriate therapy.

Safety in the Postpartum Period

The same vigilance over the antepartum and intrapartum safety of women with epilepsy should continue into the postpartum period because the 3-day peripartum period is the time of maximal seizure exacerbation.89 All new mothers with epilepsy should be counseled on the importance of therapy compliance, signs of postpartum depression, and prevention of seizure triggers such lack of sleep and increased stress.4,15 To prevent sleep deprivation, family members may need to help with night feedings to allow 6 to 8 hours of uninterrupted sleep. To counteract the likely increase in stress levels new mothers are bound to experience, AED dosage may need to be tapered to levels just above prepregnancy levels.15 Further safety prevention measures that should be emphasized to the mother and family incorporate steps to protect the newborn in case of maternal seizure.15 These measures include bathing the infant only when another caregiver is present, changing diapers on the floor instead of a changing table, using a stroller instead of a carrier that straps onto the mother, and avoiding stairs when possible.