epilepsy & intrahepatic cholestasis of pregnancy

neurological disorder

Epilepsy

Sudden intense burst of electrical activity which results in disruption to the normal functioning of the brain.

Types of seizures

Focal seizures

• Start on one part of the brain and can spread to both part

• depending on how far it spreads & what lobe is affected will present different symptoms

Absence seizure

• appear that they are day dreaming/switching off

• Lose consciousness for a couple of secs

• Blink a lot & tend to gain consciousness back quickly

Tonic clinic seizures

• More dramatic fall to floor

• Muscle stiffness ( can lead to incontinence)

• Loss of consciousness

• Strange noises

Big risk of hypoxia as muscle is stiff airway on pause

Triggers of epilepsy

Management of epilepsy

Pre conception

• Neurologist should advise and discuss about conception so if medication is needed to be changed it will be or a lower dosage needed that is safe

  AN care

• Advise 5mg/day of folic acid

• Fetal anomaly scan

  identifying major cardiac defects

• Multiple growth scans

Labour & delivery

• Labour & delivery usually smooth but extra care and caution is needed

PN care

• Advise on safety measures as seizures are more common during this period (may be due to more triggers)

What is intrahepatic cholestasis of pregnancy

Interupted bile flow from liver to gall bladder and duodenum

diagnosed with raised bile acids

Why does it occur ?

• Hormones-eostregen & progesterone

• Environment- diet

• Genes- may be caused by mutation on variant genes

Intrahepatic cause - liver cells are affected

Extra hepatic cause - external factors (e.g. gallstone,medical, tumors) is causing ICP

Symptoms

• Mild/severe itching- pruritus

• Jaundice

• Dark urine

• Pale stoll

• Link to GDm & PET

hyperamisis gravidarum