Epileptic disorders in pregnancy: an overview
ABSTRACT Much new information has now become available regarding outcomes of women with epilepsy (WWE) and pregnancy.
Valproate is associated with a risk of major congenital malformations within a range of 6.2-10.7%, though antiepileptic drugs (AEDs) other than valproate when used as monotherapy are associated with major congenital malformation rates ranging from 2.9 to 3.6%; the rate of major congenital malformations in WWE not treated with AEDs was similar to this at 3.1%. Seizure freedom in 9-12 months before pregnancy is associated with seizure freedom during pregnancy. A decline in AED levels can be expected during pregnancy, most dramatically for lamotrigine (but with marked variability between patients) and least with carbamazepine. Neonates born to WWE taking AEDs who receive vitamin K 1 mg intramuscularly at birth are not at additional risk of hemorrhagic disease of the newborn.
The use of valproate and polytherapy with any AED combinations should be avoided, if clinically appropriate, during pregnancy. Seizure freedom in 9-12 months before pregnancy should be a goal. AED levels should be maintained at or near the therapeutic level known for that individual patient, with frequent monitoring during pregnancy as appropriate for the patient and the AED.
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ABSTRACT: Critical care support and admission to an ICU is a relatively infrequent occurrence during pregnancy and the postpartum period Retrospective analyses of hospital admissions and complication rates indicate that 0.11–1.1% of deliveries are complicated by maternal ICU admission Patient demographics and hospital type clearly vary and affect outcomes differently; therefore, understanding the true risk of obstetric complications is somewhat difficult Literature suggests that these complications may account for most or only a portion of ICU admissions in pregnant patients (i.e., 19–93%); however, it is clear that maternal morbidity and mortality can be substantial when pregnant women require critical care In one study, 71% of obstetric patients transferred to the ICU required ventilatory support; other studies that indicate mortality ranges from 5 to 20% Treatment of critically ill pregnant women is challenged by limited information regarding safety profiles of therapeutic agents and the necessity to simultaneously manage mother and pregnancy viability Survival depends on care algorithms that allow for early detection of maternal problems and prompt referral to tertiary centers with ICUs Proactive and aggressive measures, including optimal cardiopulmonary management, minimize the incidence of multiorgan failure and mortality Admission criteria for appropriate triage are essential; decisions may be based on several models (which utilize prioritization) or diagnostic and objective parameters The American College of Critical Care Medicine summarized qualifications for ICU admission; this diagnostic model (Table 33.1) uses specific conditions or diseases to determine appropriateness of ICU admission General criteria for admission to an obstetric intermediate care unit are listed in Table 33.2
- Journal of Psychosocial Nursing and Mental Health Services 05/2009; 47(5):19-23. DOI:10.3928/02793695-20090331-05 · 0.87 Impact Factor
Article: Human freedom and the brain.[Show abstract] [Hide abstract]
ABSTRACT: Freedom of will does exist, it is self-leadership of man based on reason and ethos. Evidence comes from truth. Determinism cannot be proved since if you try, you mean to prove a truth; but there is no truth without freedom. By contrast for freedom there are many pieces of evidence e.g. science, arts, technology. Freedom utilizes creative abstract thinking with phantasy. Freedom is graded, limited, based on nature, but not developed without good will. We perceive reliably freedom by self-consciousness and in other persons as long as we are sober. Freedom needs intelligence, but is more, it is a creative and moral virtue. The basis for freedom is phylogenesis and culture, in the individual learning and experimenting. Factors in the becoming of freedom are not only genes and environment but also self-discipline. But the creativity of free will is dangerous. Man therefore needs morale. Drives and feelings become humanized, cultural interests are developed. There is a humane nobility from long good will.Acta Neuropsychiatrica 06/2009; 21 Suppl 2:1-6. DOI:10.1111/j.1601-5215.2009.00386.x · 0.64 Impact Factor