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Advice on maternal diseases during pregnancy

Epilepsy is the most common neurologic condition found in pregnancy. As such, all neurologists, internists, and obstetricians should know how to counsel women with epilepsy as they are considering pregnancy. Monotherapy with the lowest dose of medication needed to control seizures should be prescribed prior to conception. The risk of a stroke during pregnancy is low. However, the poor outcomes in terms of morbidity and mortality and variations in care highlight the importance of such women receiving specialist stroke care. Clinicians should be aware of an association with a history of migraine, gestational diabetes, and preeclampsia or eclampsia. The treatment of inflammatory rheumatic diseases, such as rheumatoid arthritis and systemic lupus erythematosus (anti-SSA/anti-SSB) is improving continuously. To ensure a favorable outcome, pregnancy should be started during a period of disease stability and should be monitored closely. A careful assessment of possible risks and the justified use of antirheumatic drugs before, during and after pregnancy are key issues for success. For pregnant patients with a single prior episode of venous thromboembolism associated with a transient risk factor that is no longer present and no thrombophilia, clinical surveillance antepartum and anticoagulant prophylaxis postpartum is recommended. For patients with a higher risk thrombophilia, in addition to postpartum prophylaxis, we suggest antepartum prophylactic or intermediate- dose low-molecular-weight heparin or prophylactic or intermediate-dose unfractionated heparin.

CME Prakt Fortbild Gynakol Geburtsmed Gynakol Endokrinol 2012; 8(2): 122–140

Epilepsy and pregnancy, stroke, rheumatic diseases, systemic lupus erythematosus, venous thromboembolism

Julia Knabl, Franz Kainer
Klinikum der Universität München, Klinik und Poliklinik
für Frauenheilkunde und Geburtshilfe – Innenstadt, München

Reviewer: Ulrike Friebe-Hoffmann, Düsseldorf,
und Holger Maul, Hamburg

Knabl J. Beratung ... Gynakol Geburtsmed Gynakol Endokrinol 2012; 8(2): 122–140 publiziert 31.07.2012 ©akademos Wissenschaftsverlag 2012 ISSN 1614-8533