Seizures During Pregnancy | Types And Complications

Seizures during pregnancy can pose significant risks, and it’s crucial to be aware of the possible causes and associated dangers.

Disorders characterized by seizures can affect fertility.

However, some antiseizure medications might reduce the effectiveness of oral contraceptives, leading to unintended pregnancies.

What are the types of seizures during pregnancy?

Eclampsia

Eclampsia is one of the main seizures during pregnancy which is a severe complication of hypertensive disorders during pregnancy.

It is marked by the abrupt occurrence of seizures without other neurological explanations. 

This condition may arise before, during, or after labor, with the greatest risk occurring during the initial week postpartum.

Although preeclampsia, characterized by high blood pressure and protein in the urine, usually occurs before eclampsia, it can also arise unexpectedly. 

Symptoms like intense headaches, vision problems, and changes in mental state are frequent, although eclampsia can appear abruptly. 

Prompt management, featuring seizure control through magnesium sulfate and timely delivery, is essential to avert maternal and fetal complications.

What is the danger of Eclampsia?Eclampsia is a major contributor to maternal death.

Seizures may cause serious complications such as maternal hypoxia, trauma, and aspiration pneumonia, although long-term neurological injury is uncommon. 

Certain women might experience persistent cognitive deficits, especially following repeated seizures or unmanaged severe hypertension. 

There remains ambiguity about whether the pathophysiology of antepartum eclampsia is distinct from that of postpartum eclampsia. 

In both instances, the condition frequently manifests with symptoms such as intense headaches, vision problems, and changes in mental status but it can also appear abruptly and unexpectedly.

Symptoms indicating Eclampsia

Numerous individuals may experience warning indicators prior to experiencing seizures during pregnancy triggered by eclampsia such as :

Intense headaches. 

Breathing difficulties. 

Nausea or throwing up. 

Issues with urination or infrequent urination. 

Pain in the abdomen. 

Blurred vision, double vision, or vision loss. 

Swelling in the hands, face, or ankles.

Causes of Eclampsia seizures during pregnancy

Eclampsia usually arises from preeclampsia. Elevated blood pressure due to preeclampsia exerts strain on your blood vessels.

Swelling in your brain can occur, potentially resulting in seizures.

Additional elements that lead to the onset of eclampsia involve maternal infections and inflammation, including periodontal disease and urinary tract infections.

Both of which have been associated with a higher risk of preeclampsia. 

Additionally, maternal obesity, gestational diabetes, and metabolic disorders are key factors in the onset of eclampsia.

It is probably because of the related systemic inflammation and endothelial dysfunction.

Treatment of Eclampsia

Magnesium sulfate is given mainly to avert additional seizure activity, rather than to stop the ongoing seizure.

The suggested standard loading dose is 6 g intravenously (IV) over 15 to 20 minutes, followed by a maintenance dose of 2 g per hour.

For patients lacking IV access, an alternative regimen may involve administering a loading dose of 10 g of magnesium sulfate intramuscularly, followed by a maintenance dose of 5 g intramuscularly every 4 hours.

For patients with contraindications to magnesium sulfate (such as myasthenia gravis, hypocalcemia.

Renal failure, cardiac ischemia, heart block, or myocarditis, other anti seizure treatments like phenytoin and diazepam could be considered.

Levetiracetam might be a better choice for those with myasthenia gravis, a condition that phenytoin could worsen.

Epilepsy

Epilepsy is one  of the difficult neurological seizures during pregnancy.

It is described as the occurrence of two or more unprovoked seizures>

It represents the clinical manifestation of an abnormal, excessive, purposeless, and synchronized electrical discharge in brain cells known as neurons.

Although the occurrence of epilepsy during pregnancy is below 1%.

It poses significant risks of injury and has considerable impacts on both the mother and fetus from conception through the postpartum period if not adequately monitored. 

Furthermore, the maternal mortality rate is 10 times greater in those with seizure disorders during pregnancy compared to those without.

As antiepileptic drugs (AEDs) are crucial for treatment, the wide range of interactions between these medications and pregnancy or lactation constantly puts clinicians in a difficult situation.

Symptoms of Epilepsy seizures during pregnancy

The symptoms are identical to those experienced when a woman is not expecting.

A woman suffering from epilepsy experiences frequent or regular seizures without any identified cause.

Along with seizures, the prevalent symptoms consist of:

Headache.

Changes in mood or energy level.

Dizziness.

Fainting.

Confusion.

Memory loss.

Causes of Epilepsy seizures during pregnancy

Pregnancy does not lead to epilepsy. However, a pregnant woman with epilepsy might experience more frequent seizures.

This could be due to the fact that medications for epilepsy might behave differently while pregnant. 

They might not be taken in as effectively.

Alternatively, they might not function as effectively.

Additionally, women experiencing nausea and vomiting during early pregnancy might vomit the medication before it takes full effect.

Treatment of Epilepsy seizures during pregnancy

A physician might recommend specific anti-seizure drugs that are safe for use during pregnancy.

The medications lamotrigine and levetiracetam might be safer for use in pregnancy compared to other anti-seizure drugs.

Certain anti-seizure drugs might not be appropriate for use during pregnancy.

Sodium valproate might raise the likelihood of birth defects or developmental and learning challenges in the infant.

Using the anti-seizure medication topiramate in early pregnancy might raise the risk of a baby being born with a cleft lip or palate.

The risk may be higher for individuals using topiramate mainly to manage epilepsy, potentially because of elevated doses.

Management of Epilepsy

Measures to assist in managing epilepsy seizures during pregnancy involve:

Taking any AEDs as prescribed by a doctor.

Consuming folic acid prior to and throughout pregnancy, which might aid in the prevention of birth defects.

Participating in all prenatal appointments and any consultations with neurologists and obstetricians

Notifying a physician of any alterations in seizures.

Complication of Seizures during pregnancy

Maternal risks

In pregnant women, seizures can lead to stroke, coma, and potentially death.

Fetal dangers

Seizures may elevate the likelihood of preterm delivery, reduced birth weight, and various developmental issues in the infant.

 Conclusion:

The majority of seizures during pregnancy happen as a result of pre-existing epilepsy.

Pregnancy can influence both the intensity of seizures and their occurrence frequency.

Seizures during pregnancy can affect both the mother and the fetus badly, so every pregnant woman should know alot about seizures during pregnancy.