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全面强直-阵挛发作

Generally, women and girls may be reassured that the risk of a tonic–clonic seizure during the labour and the 24 hours after birth is low (1–4%). [2004] 一般来说，女性患者可以放心，在分娩期间和孩子出生后 24 小时内发生强直-阵挛性发作的风险很低（1-4%）。 [2004] Women and girls with generalised tonic–clonic seizures should be informed that the fetus may be at relatively higher risk of harm during a seizure, although the absolute risk remains very low, and the level of risk may depend on seizure frequency. [2004] 应告知患有全面强直-阵挛发作的女性，尽管绝对风险仍然非常低，但胎儿在癫痫发作期间可能处于相对较高的伤害风险中，并且风险水平可能取决于癫痫发作频率。 [2004] nice.org.uk/guidance/cg137

Generalised tonic-clonic seizure

The rates of seizure deterioration in pregnancy may be associated with the type of seizure.Uncontrolled tonic-clonic seizures are the strongest risk factor for SUDEP, which are the main cause of death in pregnant WWE.（SUDEP is defined as ‘sudden, unexpected, witnessed or unwitnessed, nontraumatic and nondrowning death in patients with epilepsy, with or without evidence for a seizure and excluding documented status epilepticus, in which postmortem examination does not reveal a toxicologic or anatomic cause for death.） 妊娠期癫痫发作恶化的比例与癫痫发作类型有关。GTCS是SUDEP的最大危险因素，是妊娠期WWE死亡的主要原因。 https://www.rcog.org.uk/guidance/browse-all-guidance/green-top-guidelines/epilepsy-in-pregnancy-green-top-guideline-no-68/

[GRADES OF RECOMMENDATION:D] Intrapartum generalised tonic-clonic seizures that are not due to eclampsia should be terminated as soon as possible.If the seizure persists, this should be managed as for status epilepticus. D级推荐：应尽快终止非子痫引起的全身强直-阵挛发作；如果痫性发作持续，应按照癫痫持续状态处理。 Scottish Intercollegiate Guidelines Network.Diagnosis and management of epilepsy in adults. SIGN 143. Edinburgh, SIGN, 2015. Available at: www.sign.ac.uk/guidelines/fulltext/143/index.html

A history of epilepsy alone is not an indication for delivery by Caesarean section. Elective Caesarean section should be considered if there have been frequent tonic-clonic or prolonged focal seizures during the third trimester of pregnancy in order to avoid adverse outcomes associated with intrapartum seizures. 癫痫病史并不是剖腹产的指征。如果在妊娠晚期有频繁的强直-阵挛发作或持续时间较长的局灶性癫痫发作，应考虑择期剖宫产，以避免产时癫痫发作带来不良后果。 Scottish Intercollegiate Guidelines Network.Diagnosis and management of epilepsy in adults. SIGN 143. Edinburgh, SIGN, 2015. Available at: www.sign.ac.uk/guidelines/fulltext/143/index.html

[GRADES OF RECOMMENDATION:D] As good seizure control during pregnancy is more likely in women whose seizures are controlled prior to becoming pregnant an effort should be made to optimise seizure control prior to pregnancy(particularly for generalised tonic-clonic seizures). D级推荐：在怀孕前即控制癫痫发作的女性癫痫患者更可能在妊娠期达到控制癫痫发作，所以应在怀孕前优化治疗（尤其是对于全身强直-阵挛发作）。 Scottish Intercollegiate Guidelines Network.Diagnosis and management of epilepsy in adults. SIGN 143. Edinburgh, SIGN, 2015. Available at: www.sign.ac.uk/guidelines/fulltext/143/index.html

Following a generalised tonic-clonic seizure during labour (irrespective of aetiology) delivery should be expedited once the maternal condition is stable. Neonatal expertise should be available. 无论有何病因，在分娩期间若出现全身强直-阵挛发作，一旦产妇病情稳定，应尽快分娩。 Scottish Intercollegiate Guidelines Network.Diagnosis and management of epilepsy in adults. SIGN 143. Edinburgh, SIGN, 2015. Available at: www.sign.ac.uk/guidelines/fulltext/143/index.html

Generalised tonic-clonic seizure without focal onset Primarily generalized tonic-clonic seizures Generalized tonic-clonic seizures without focal onset Primary generalised tonic-clonic seizures Bilateral tonic-clonic seizure with generalised onset Bilateral tonic-clonic seizure with generalized onset Generalized tonic-clonic seizure without partial onset Generalised tonic-clonic seizure without partial onset Primarily generalised tonic-clonic seizures Generalized-onset tonic-clonic seizure Generalised tonic-clonic seizures without focal onset Generalised-onset tonic-clonic seizure Generalized tonic-clonic seizure without focal onset Primary generalized tonic-clonic seizures Primary generalised tonic-clonic seizure Primary generalized tonic-clonic seizure

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