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Table 32.5

Differential Diagnosis of Seizures in Pregnancy

DiagnosisKey featuresManagement
Epilepsy

Seizures may occur at increased frequency even if epilepsy previously well controlled, as a result of:

Dose reduction because of concern about teratogenicity

Increased metabolism of AEDs

Precipitants such as sleep deprivation

Consider drug level to help guide dose adjustment

Management of status epilepticus as in non-pregnant patient

EclampsiaMay not have been preceded by hypertension, proteinuria or symptoms of pre-eclampsia
Cerebral venous thrombosisSee headache section
Intracranial haemorrhageSee headache section
Thrombotic thrombocytopenic purpuraFeatures: microangiopathic haemolytic anaemia (MAHA), fever, renal impairment, neurological symptoms and low platelets, but often not all features are presentInitiation of plasma exchange should be considered in all patients with MAHA and low platelets without another obvious cause
Hypoglycaemia

Usually in women taking exogenous insulin

Less commonly: acute fatty liver of pregnancy, adrenal or pituitary disease, insulinomas

Parenteral glucose
HypocalcaemiaCan be associated with magnesium sulphate therapy or hypoparathyroidismIntravenous calcium
Drug or alcohol withdrawalAs in non-pregnant population