Maternal Complex Partial Seizure Associated With Fetal Distress

Abstract

e describe a 43-year-old woman who had a complex partial seizure in the seventh month of pregnancy with simultaneous fetal heart rate monitoring. The seizure was accompanied by fetal heart rate decelerations, indicating fetal distress. Maternal partial seizures can be associated with fetal distress.

Two cases of focal status epilepticus in pregnancy

“…During the seizure, the fetal heart rate fell from 160 to 70 bpm and returned to baseline two minutes after the seizure. Maternal autonomic instability was also seen with oxygen saturations down to 75% and a concomitant heart rate of 125 that improved after her seizure [7] . Aside from autonomic instability, the direct effect of focal seizures on placental blood flow, fetal acidemia, and other factors remains unknown.…”

“…At least one prior case report has demonstrated a fall in fetal heart rate after a brief event associated with transient maternal hypoxia [6] . Another report by Sahoo and Klein refers to a patient who experienced focal seizures secondary to cavernous hemangiomas while seven months pregnant [7] . During the seizure, the fetal heart rate fell from 160 to 70 bpm and returned to baseline two minutes after the seizure.…”

Two cases of focal status epilepticus in pregnancy

“…During the seizure, the fetal heart rate fell from 160 to 70 bpm and returned to baseline two minutes after the seizure. Maternal autonomic instability was also seen with oxygen saturations down to 75% and a concomitant heart rate of 125 that improved after her seizure [7] . Aside from autonomic instability, the direct effect of focal seizures on placental blood flow, fetal acidemia, and other factors remains unknown.…”

“…At least one prior case report has demonstrated a fall in fetal heart rate after a brief event associated with transient maternal hypoxia [6] . Another report by Sahoo and Klein refers to a patient who experienced focal seizures secondary to cavernous hemangiomas while seven months pregnant [7] . During the seizure, the fetal heart rate fell from 160 to 70 bpm and returned to baseline two minutes after the seizure.…”

Epilepsy and Pregnancy

“…Convulsions are dangerous to women with epilepsy not only because of the risk of seizure-related falls and blunt trauma but also because of potential harm to the fetus from the possibility of hypoxemia and asphyxia. Focal seizures that do not evolve to convulsions are thought unlikely to have a major impact on the fetus, but anecdotal evidence indicates that they may cause transient fetal distress, with fetal heart rate deceleration for up to 2.5 minutes 26 . The fundamental reason that women with epilepsy are continuously treated with antiseizure medications throughout pregnancy is to avoid recurrence of seizure activity and its related adverse effects.…”

Executive Summary: Management of epilepsy in pregnancy: A report from the International League Against Epilepsy Task Force on Women and Pregnancy

“…The risk of seizures during pregnancy and the consequences that they might have on the developing foetus as well as the mother are fundamental reasons for the use of AEDs, and this should be no different for epileptic women with childbearing potential as they may become pregnant (Sveberg et al, 2015). Focal seizures that do not evolve to bilateral tonicclonic seizures are unlikely to have a major impact on the foetus, although there are a few case reports indicating brief foetal distress, expressed as deceleration of foetal heart rate for 2.5-3.5 minutes, during focal seizures with impaired awareness (Nei et al, 1998;Sahoo and Klein, 2005). Generalized tonic-clonic seizures (GTCS), including focal to bilateral tonicclonic seizures according to the current classification (Fisher et al, 2017), are associated with hypoxia and lactic acidosis, which during pregnancy are transferred to the foetus through the placenta and may lead to asphyxia (Hiilesmaa and Teramo, 2013).…”

Two cases of focal status epilepticus in pregnancy

“…During the seizure, the fetal heart rate fell from 160 to 70 bpm and returned to baseline two minutes after the seizure. Maternal autonomic instability was also seen with oxygen saturations down to 75% and a concomitant heart rate of 125 that improved after her seizure [7] . Aside from autonomic instability, the direct effect of focal seizures on placental blood flow, fetal acidemia, and other factors remains unknown.…”

“…At least one prior case report has demonstrated a fall in fetal heart rate after a brief event associated with transient maternal hypoxia [6] . Another report by Sahoo and Klein refers to a patient who experienced focal seizures secondary to cavernous hemangiomas while seven months pregnant [7] . During the seizure, the fetal heart rate fell from 160 to 70 bpm and returned to baseline two minutes after the seizure.…”

Epilepsy and Pregnancy

“…Convulsions are dangerous to women with epilepsy not only because of the risk of seizure-related falls and blunt trauma but also because of potential harm to the fetus from the possibility of hypoxemia and asphyxia. Focal seizures that do not evolve to convulsions are thought unlikely to have a major impact on the fetus, but anecdotal evidence indicates that they may cause transient fetal distress, with fetal heart rate deceleration for up to 2.5 minutes 26 . The fundamental reason that women with epilepsy are continuously treated with antiseizure medications throughout pregnancy is to avoid recurrence of seizure activity and its related adverse effects.…”

Executive Summary: Management of epilepsy in pregnancy: A report from the International League Against Epilepsy Task Force on Women and Pregnancy

“…The risk of seizures during pregnancy and the consequences that they might have on the developing foetus as well as the mother are fundamental reasons for the use of AEDs, and this should be no different for epileptic women with childbearing potential as they may become pregnant (Sveberg et al, 2015). Focal seizures that do not evolve to bilateral tonicclonic seizures are unlikely to have a major impact on the foetus, although there are a few case reports indicating brief foetal distress, expressed as deceleration of foetal heart rate for 2.5-3.5 minutes, during focal seizures with impaired awareness (Nei et al, 1998;Sahoo and Klein, 2005). Generalized tonic-clonic seizures (GTCS), including focal to bilateral tonicclonic seizures according to the current classification (Fisher et al, 2017), are associated with hypoxia and lactic acidosis, which during pregnancy are transferred to the foetus through the placenta and may lead to asphyxia (Hiilesmaa and Teramo, 2013).…”

Two cases of focal status epilepticus in pregnancy

“…During the seizure, the fetal heart rate fell from 160 to 70 bpm and returned to baseline two minutes after the seizure. Maternal autonomic instability was also seen with oxygen saturations down to 75% and a concomitant heart rate of 125 that improved after her seizure [7] . Aside from autonomic instability, the direct effect of focal seizures on placental blood flow, fetal acidemia, and other factors remains unknown.…”

“…At least one prior case report has demonstrated a fall in fetal heart rate after a brief event associated with transient maternal hypoxia [6] . Another report by Sahoo and Klein refers to a patient who experienced focal seizures secondary to cavernous hemangiomas while seven months pregnant [7] . During the seizure, the fetal heart rate fell from 160 to 70 bpm and returned to baseline two minutes after the seizure.…”

Epilepsy and Pregnancy

“…Convulsions are dangerous to women with epilepsy not only because of the risk of seizure-related falls and blunt trauma but also because of potential harm to the fetus from the possibility of hypoxemia and asphyxia. Focal seizures that do not evolve to convulsions are thought unlikely to have a major impact on the fetus, but anecdotal evidence indicates that they may cause transient fetal distress, with fetal heart rate deceleration for up to 2.5 minutes 26 . The fundamental reason that women with epilepsy are continuously treated with antiseizure medications throughout pregnancy is to avoid recurrence of seizure activity and its related adverse effects.…”

Executive Summary: Management of epilepsy in pregnancy: A report from the International League Against Epilepsy Task Force on Women and Pregnancy

“…The risk of seizures during pregnancy and the consequences that they might have on the developing foetus as well as the mother are fundamental reasons for the use of AEDs, and this should be no different for epileptic women with childbearing potential as they may become pregnant (Sveberg et al, 2015). Focal seizures that do not evolve to bilateral tonicclonic seizures are unlikely to have a major impact on the foetus, although there are a few case reports indicating brief foetal distress, expressed as deceleration of foetal heart rate for 2.5-3.5 minutes, during focal seizures with impaired awareness (Nei et al, 1998;Sahoo and Klein, 2005). Generalized tonic-clonic seizures (GTCS), including focal to bilateral tonicclonic seizures according to the current classification (Fisher et al, 2017), are associated with hypoxia and lactic acidosis, which during pregnancy are transferred to the foetus through the placenta and may lead to asphyxia (Hiilesmaa and Teramo, 2013).…”