妊娠合并癫15例临床分析

Risk and management of 15 cases of pregnancies with epilepsy

目的 探讨妊娠合并癫痫的风险以及适当的处理。方法 回顾性分析我院1984年至2004年妊娠合并癫痫15例孕妇的病史，记录其年龄、产次、孕周、癫痫类型以及孕期发作情况、孕期的处理、分娩时情况、新生儿的情况等。结果 妊娠合并癫痫的发生率0．06％。年龄20～29岁6例（40％），30～36岁9例（60％）。初产妇14例，经产妇1例。〈37孕周1例，〉37孕周14例。66．7％的患者存20岁以前发病，33．3％的患者20岁以后发病。孕期发作频率增加者5例（33．3％），孕期发作频率减少者1例（6．7％），无变化者9例（60％）（7例患者孕期无发作）。单药治疗的10例（66．7％）；多药治疗的4例（26．7％）；末治疗的1例（6．6％）。新生儿Apgar评分均为10分，并且没有发现一例畸形。产后2例母乳喂养。结论患有癫痫的妇女建议孕前咨询。指导方针为孕前优化抗癫痫药物，稳定症状并加服叶酸。建议孕期密切监测血药浓度，及时调整用量。

Objective To study the risk of pregnant women with epilepsy and its appropriate treatment. Methods A retrospective medical records review was conducted in 15 pregnant women with epilepsy at Peking Union Medical College Hospital from 1984 to 2004. The data were collected including maternal age at delivery, parity, gestational weeks at delivery, types of epilepsy, occurrence of seizures during trimester, mode of delivery and neonatal outcome. Results The prevalence of pregnancy with epilepsy was 0.06%. Six cases（40%）wereaged 20-29, and 9 （60%） aged 30-36. There were 14 primigravidas, and 1 multiparity. One case delivered before 37 weeks and 14 after 37 weeks. The onset of epilepsy occurred before the age of 20 in 66. 7% of women. During pregnancy, the number of occurrence of seizures increased in 5 patients （33.3%）, decreased in 1 patient（6.7%）, 9 cases（60%）were the same to non-pregnant period and 7 cases（46.7%）had no seizures. Ten women （66.7%） were on mono-medication, while 4 （26. 7%） eases were on combined medication and 1 （6.6%） patient without medication. The Apgar＇s score of all children was 10 at delivery and no congenital malformation was found. Two cases had breast-feeding postpartum. Conclusions Women with epilepsy should have prepregnant counseling. The lowest dose of antiepileptic drug （AED） and folic acid supplementation should be recommended before anticipated conception. During trimester, the blood concentration of AED should be closely monitored in order to adjust the dose. The prenatal outcome will be improved with proper management.