Background
Acute maternal seizures are rare, but can cause significant morbidity. Timely and accurate diagnosis of seizure etiology is necessary to improve maternal and fetal outcomes. This study describes the presentation and management of maternal seizures in pregnancy at our centre.
Methods
We performed a 10-year retrospective chart review of patients admitted to BC Women's Hospital, referred to Obstetric Internal Medicine with an acute maternal seizure in pregnancy. Patient demographics, investigations, management, maternal and neonatal outcomes were collected.
Results
The prevalence of acute maternal seizures over a decade was 0.06% (44/70000). Mean maternal age was 30.7 years; 41% were nulliparous. The main seizure etiology was eclampsia 14/44 (32%); others included epilepsy 9/44 (21%), psychogenic 8/44 (18%) and substance-use 5/44 (11%). Most patients had neuroimaging 35 (80%): CT in 33 (75%) and MRI in 16 (36%). Of the 14 with eclampsia, 11 (79%) had findings on neuroimaging. The main neuroimaging findings in patients with eclampsia were PRES 11/14 (79%), RCVS 2/14 (14%), ICH 1/14 (7%) and SAH 1/14 (7%). Fifty-two percent of seizures occurred antepartum, 13% intrapartum, and 34% postpartum. Pharmacological therapies for acute seizure management included magnesium sulfate 19/44 (43%), benzodiazepines 14/44 (32%), antihypertensives 12/44 (27%), and antiepileptics 10/44 (23%). NICU admission occurred for 20% of neonates.
Conclusion
Eclampsia was the predominant cause of acute maternal seizure in pregnancy. Most patients with eclampsia had findings on neuroimaging, the most common was PRES in 79%.