Differential Diagnosis of Seizures in Pregnancy
Diagnosis | Key features | Management |
---|---|---|
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 |
Eclampsia | May not have been preceded by hypertension, proteinuria or symptoms of pre-eclampsia | |
Cerebral venous thrombosis | See headache section | |
Intracranial haemorrhage | See headache section | |
Thrombotic thrombocytopenic purpura | Features: microangiopathic haemolytic anaemia (MAHA), fever, renal impairment, neurological symptoms and low platelets, but often not all features are present | Initiation 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 |
Hypocalcaemia | Can be associated with magnesium sulphate therapy or hypoparathyroidism | Intravenous calcium |
Drug or alcohol withdrawal | As in non-pregnant population |