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INTRODUCTION Injury or Illness to an Expectant Mother Can Affect

INTRODUCTION Injury or Illness to an Expectant Mother Can Affect

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01/12/2013

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INTRODUCTION
Injury or illness to an expectant mother can affect the developing brain in thefetus during pregnancy. Heredity are continually examining the role of heredity and genetics in the development of seizure disorders. It might help tokeep a diary and keep track of events, this may help show a pattern whichmay pinpoint an avoidable cause.
Infections illnesses.
Fever.
Fatigue.
Low blood sugar due to poor diet.
Stress or anxiety.
Insomnia.
Alcoholism and drug abuse.
Uncommon medicines, anti–depressants, anti–psychotic medication.
DEFINITION
.Epilepsy can be defined as a group of disorders characterized by abnormalelectrical activity in the brain leading to altered behavior which may manifestas a change in a person’s consciousness, movement, or actions. Thesephysical changes are called epileptic seizures.Epilepsy is therefore sometimescalled a seizure disorder.
CAUSES OF EPILEPSY Head injury:
People who sustain a head injury as a result of an automobileaccident, sports injury, fall, or act of violence may develop epilepsy. 
Birth trauma:
Infants who suffer a lack of oxygen during birth may developresulting damage to the brain’s electrical system.
Poisoning:
Lead poisoning has been associated with the development of epilepsy.
Infection:
Infections that can affect the brain like meningitis, viral encephalitis,mumps, measles, and diphtheria can result in epilepsy
CLINICAL MANIFESTATIONS
Blunt trauma
Miscarriage
Premature rupture of membranes
 
Placental abruption.
 The indicates that antiepileptic drug(AED) used to treat epilepsy are the majorcause of foetal defects like clept lip and palate ,cardiac defects and neuraltube defects.
EFFECTS OF EPILEPSY ON PREGNANCY 
Incidence of fetal malformations,IUGR, oligohydramnios and still births isincreased.Birth defects are increased by two fold.This could be related to theseverity of the disease with its genetic predilection and also due to thehazards of anticonvulsants used.All the drugs are implicated,maximum withphenytoin and least with carbamazepine.The malformations include-cleftlipand/or plate,mental retardation,cardiac abnormalities,limb defects andhypoplasia of the terminal phalanges.Sodium valproate is associated withneural tube defects.There is chance of neonatal haemorrhage and is related toanticonvulsant induced vitamin k dependent coagulopathy.
MANAGEMENT
: The dose of the drug should be kept as low as possible and to be monitoredregularly from the serum level. The commonly used drugs are:
Phenobarbitone 60-180 mg daily in 2-3 divided doses.
Phenytoin 150-300 mg daily in two divided doses.
Carbamazepine 0.8-1.2mg daily in divided doses.
 The fits are controlled by intravenous diazepam 10-20 mg.
Folic acid 1 mg must be continued throughout pregnancy.
And beginning 36 weeks many physician prescribe vitamin K 10mgsupplementation because AED therapy can lead to vitamin K –deficienthemorrhage of the newborn.termination of pregnancy may have to beconsidered in consultation with a neurologist.
 There is no contraindication for breast feeding.The infant may bedrowsy.Readjustment of the anticonvulsant dosage is necessary and tobring down the dose to the pre-pregnant level by 4-6 weekspostpartum.Steroidal contraceptives are better to be avoided due tohepatic microsomal enzyme induction.
HEPATIC NECROSIS
 
Acute viral hepatitis is the most common cause of jaundice in pregnancy. Thecourse of acute hepatitis is unaffected by pregnancy, except in patients withhepatitis E and disseminated herpes simplex infections, in which maternal andfetal mortality rates are significantly increased. Chronic hepatitis B or Cinfections may be transmitted to neonates; however, hepatitis B virustransmission is effectively prevented with perinatal hepatitis B vaccination andprophylaxis with hepatitis B immune globulin. Cholelithiasis occurs of pregnancies; complications can safely be treated with surgery. Women withchronic liver disease or cirrhosis exhibit a higher risk of fetal loss duringpregnancy. Preeclampsia is associated with HELLP syndrome, acute fatty liverof pregnancy, and hepatic infarction and rupture. These rare diseases result inincreased maternal and fetal mortality. Treatment involves prompt delivery,whereupon the liver disease quickly reverses. Therapy with penicillamine,trientine, prednisone or azathioprine can be safely continued duringpregnancy.
PREGNANCY AND HEPATITISACUTE VIRAL HEPATITIS
Viral hepatitis is the most common cause of jaundice in pregnancy.The courseof most viral hepatitis infections (e.g., hepatitis A, B, C and D) is unaltered bypregnancy. However, a more severe course of viral hepatitis in pregnancy hasbeen noted in patients with hepatitis E and disseminated herpes simplex virus(HSV) infections.
Hepatitis E is a waterborne virus spread through fecal-oral transmission.Infection occurs most commonly in developing countries after flooding.Pregnant women with hepatitis E infection exhibit markedly increased fatalityrates
Disseminated HSV infection is associatedwith prodromal systemic illness, vesicular skin rash and leukopenia. Maternaland fetal mortality rates reach without treatment. Acyclovir (Zovirax)effectively treats early disseminated HSV infection.
HEPATITIS D
It is seen in patients infected with HBV either as a co-infection .Perinataltransmission is known.Neonatal immunoprophylaxis for HBV is almosteffective against HDV.
 
HEPATITIS B VIRUS 
Pregnant women who are hepatitis B surface antigen (HBsAg)-positive deliverannually. Universal screening of pregnant women for HBsAg is now performedto reduce perinatal transmission of hepatitis B virus. It is transmitted by

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