(642) Epilepsy in pregnancy – patient safety challenges in contemporary practice.

Pregnant patients with epilepsy are at particularly high risk of maternal and fetal morbidity and mortality, likely in large part due to suboptimal medication prescribing. In our health system a recent tragic case of a double maternal / neonatal death in a woman with epilepsy triggered a quality improvement analysis of our practice in this regard. We analysed the care received by this patient cohort in a large obstetric hospital with over 10,000 pregnancies per annum.

Study Design:

A prospectively-maintained database of patients with epilepsy in pregnancy at a single large obstetric hospital was interrogated for the 6-month time period of July to December 2021 for metrics of good clinical practice in the obstetric management of epilepsy. This included patient engagement with specialist services, adequacy of pre-conceptional care and anti-epileptic drug (AED) prescribing patterns.

Results:

During the 6-month study period, a total of 50 women reported at initial antenatal visit as having a seizure disorder, 26 (52%) of whom had a confirmed diagnosis of epilepsy. 46 of 50 (96%) had complete care provided through a specialist epilepsy in pregnancy service, but only 2/50 (4%) had completed formal pre-conceptional consultation with a neurologist or primary care provider. Amongst the 17 patients using AED, a total of 17/24 (70%) had adequate AED prescription completed and in place to cover the peripartum period. However, appropriate recording of self-administered AEDs during the peripartum period was confirmed in the hospital electronic healthcare record system in only 13/24 (54%) of cases.

Conclusion:

While it is reassuring to confirm specialist engagement with services for the majority of patients with epilepsy, our study demonstrates significant room for improvement. Given the significant risk of undermedication for these patients in the peripartum period, inadequacy of documentation of AED medication poses a serious risk to the health and safety of these patients. Our study calls for significant additional investment in pre-conceptional and antenatal care systems to minimise this risk.