Status epilepticus in pregnancy — emergency management station

Emergency management station on status epilepticus in pregnancy. Tests the candidate on the status epilepticus bundle with drug doses, exclusion of eclampsia, fetal monitoring, and the postpartum plan including the lamotrigine clearance and dose-reduction principles. Includes assessor key and marking domains.

Prompt

A 29-year-old G2P1 at 34 weeks gestation with known focal epilepsy on lamotrigine 200 mg daily is brought to the maternity assessment unit by ambulance. She has had three generalised tonic-clonic seizures in the past 40 minutes, the most recent ongoing for the past 8 minutes and not terminating. Observations: HR 124 bpm, BP 138/84 mmHg, RR 18, oxygen saturation 92 percent on room air. Her partner reports she stopped taking her lamotrigine two weeks ago because of nausea. The fetus is being monitored by paramedics with a reactive cardiotocography.

Station brief

Format. Emergency management station, approximately 12 minutes. You are the obstetric registrar in the maternity assessment unit. A midwife, an anaesthetist and a neurology registrar are available on call. The assessor will run the clock and feed you new information. ^[1]

Candidate instruction. Lead the management of status epilepticus in pregnancy. Verbalise your drug orders with doses, your escalation triggers, your exclusion of eclampsia, and your communication with the team. ^[1]^[2]

References4Show

[1]Pack AM, Oskoui M, Williams Roberson S, Donley DK, French J, Gerard EE, Gloss D, Miller WR, Munger Clary HM, Osmundson SS, McFadden B, Parratt K, Pennell PB, Saade G, Smith DB, Sullivan K, Thomas SV, Tomson T, Dolan O'Brien M, Botchway-Doe K, Silsbee HM, Keezer MR Teratogenesis, Perinatal, and Neurodevelopmental Outcomes After In Utero Exposure to Antiseizure Medication: Practice Guideline From the AAN, AES, and SMFM Neurology, 2024.PMID 38748979
[2]Harden CL, Pennell PB, Koppel BS, et al. Practice parameter update: management issues for women with epilepsy--focus on pregnancy (an evidence-based review): vitamin K, folic acid, blood levels, and breastfeeding: report of the Quality Standards Subcommittee and Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology and American Epilepsy Society Neurology, 2009.PMID 19398680
[3]Reisinger TL, Newman M, Loring DW, Pennell PB, Meador KJ Antiepileptic drug clearance and seizure frequency during pregnancy in women with epilepsy Epilepsy Behav, 2013.PMID 23911354
[6]Tomson T, Battino D, Bonizzoni E, et al. Comparative risk of major congenital malformations with eight different antiepileptic drugs: a prospective cohort study of the EURAP registry Lancet Neurol, 2018.PMID 29680205

Status epilepticus in pregnancy — emergency management station

Station brief

References4Show

[1]Pack AM, Oskoui M, Williams Roberson S, Donley DK, French J, Gerard EE, Gloss D, Miller WR, Munger Clary HM, Osmundson SS, McFadden B, Parratt K, Pennell PB, Saade G, Smith DB, Sullivan K, Thomas SV, Tomson T, Dolan O'Brien M, Botchway-Doe K, Silsbee HM, Keezer MR Teratogenesis, Perinatal, and Neurodevelopmental Outcomes After In Utero Exposure to Antiseizure Medication: Practice Guideline From the AAN, AES, and SMFM Neurology, 2024.PMID 38748979
[2]Harden CL, Pennell PB, Koppel BS, et al. Practice parameter update: management issues for women with epilepsy--focus on pregnancy (an evidence-based review): vitamin K, folic acid, blood levels, and breastfeeding: report of the Quality Standards Subcommittee and Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology and American Epilepsy Society Neurology, 2009.PMID 19398680
[3]Reisinger TL, Newman M, Loring DW, Pennell PB, Meador KJ Antiepileptic drug clearance and seizure frequency during pregnancy in women with epilepsy Epilepsy Behav, 2013.PMID 23911354
[6]Tomson T, Battino D, Bonizzoni E, et al. Comparative risk of major congenital malformations with eight different antiepileptic drugs: a prospective cohort study of the EURAP registry Lancet Neurol, 2018.PMID 29680205