Page 1 of 3: Antiepileptics in pregnancy:

candy · Credits: 15282 My Scrapbook

A 25 years old primigravida reports at 6 weeks gestation with h/o seizure disorder. She has been on phenytoin for the last 6 months. The appropriate management in this case would be

One answer only.

a) Continue phenytoin and adjust the levels as per serum levels
b) Stop phenytoin and start barbiturates
c) Terminate pregnancy as phenytoin has had its teratogenic effect
d) Stop phenytoin and terminate pregnancy if sonography detects malformations.

ardy · Credits: 12764 My Scrapbook

ans is a.
explanation
the overall incidence of fetal abnormalitiesin children born to mothers wth epilepsy is 5%-6%compared to 2%-3% in normal delivery.since the potential harm of uncontrolled seizures on mother and fetus is considerd greater thn th teratogenic effects,it is currently recoomended to maintain an effective drug therapy in pregnancy,it is prudent to go fr a lowest effective dose /monotherapy in 1st trimester.patient should also take folate 4mg/day.
i hope hat is helpful

candy · Credits: 15282 My Scrapbook

thanks ardy..
That sure is helpful, but arent there drugs which can be given for epilepsy that r safer n have less teratogenic effects than phenytoin?

BRAVO · Credits: 45704 My Scrapbook

phenobarb is much safer in pregnacy whats the answer given candy!!!

suneet · Credits: 6840 My Scrapbook

but if the pt is under control with phenytoin then why change n as said incidence of fetal abnormality is low why make pt to suffer through a probable episode of fits with change of drug

ardy · Credits: 12764 My Scrapbook

the first line antiepileptics used (valproic and carbamazepine)is assoc wth 1%-2% of incidence of neural tube defects compared to baseline 0.5%-1%,little is known ab safety of newer drugs,so it is advisan=ble to continue phenytoin possibly monotherapy as in multidrug therapy incidence of malforamation is 10%.

draditithegreat · Credits: 1247960 My Scrapbook

btw whats

DOC of epilepsy in pregnancy is carbamazepine or phenobarb??????????

partha_aipg · Credits: 13118 My Scrapbook

hmmm.yes the drug should be continued but should we switch over to a drug with less teratogenic potential like pheno barbitone or carbamazepine ? plz someone clarify this point.

and aditi carbamazepine is now the doc in pregnancy(sorry i forgot where i read it but i'm fairly sanguine about it).

partha

manpreet108 · Credits: 30682 My Scrapbook

i ve a doubt...

this lady is in her 6 th wk of gestation..and has been taking phenytoin throuout this crucial period of organogenesis in fetus...
must have borne the blunt--so dont we need to confirm this by sonography before being sure to continue pregnancy with an altered drug??
that way --d can be an ans too..

whats the ans given candy??

candy · Credits: 15282 My Scrapbook

I too thought the same as u manu.. but ans given is A.
this ques is from one of our mock tests!!
I'm findin it difficult to get convinced that phenytoin can b continued. evn tho the teratogenic effect is small, its still there na..
ideally shouldnt we do a scan to rule out any malformations.. if prt then terminate pregnancy or else switch to safer drug like carbamazepine??

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