Delivery

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分娩期抗癫痫治疗

Delivery

Delivery of the FETUS and PLACENTA under the care of an obstetrician or a health worker. Obstetric deliveries may involve physical, psychological, medical, or surgical interventions.

Women and girls with epilepsy should be informed that although they are likely to have healthy pregnancies, their risk of complications during pregnancy and labour is higher than for women and girls without epilepsy. [2004] 应告知女性癫痫患者，尽管她们的妊娠可能是正常的，但她们在怀孕和分娩期间发生并发症的风险高于未患癫痫的其他女性。 [2004] All children born to mothers taking enzyme-inducing AEDs should be given 1 mg of vitamin K parenterally at delivery. [2004] 所有服用酶诱导型抗癫痫药物的母亲所生的孩子都应在分娩时肠胃外给予 1 mg 维生素 K。 [2004] 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]（pregnancy） 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] The risk of seizures during labour is low, but it is sufficient to warrant the recommendation that delivery should take place in an obstetric unit with facilities for maternal and neonatal resuscitation and treating maternal seizures.[2004] 分娩期间癫痫发作的风险很低，但建议最好保证分娩应在具有孕产妇和新生儿复苏和治疗产妇癫痫发作设施的产科进行。[2004] It is, however, important that there should be regular follow-up, planning of delivery, and liaison between the specialist or epilepsy team and the obstetrician or midwife. [2004] 然而，重要的是应该定期随访、计划分娩以及专科医生或癫痫团队与产科医生或助产士之间的及时沟通。 [2004] Women and girls should be reassured that an increase in seizure frequency is generally unlikely in pregnancy or in the first few months after birth. [2004] 应该让女性患者放心，在怀孕期间或分娩后的最初几个月，癫痫发作频率通常不太可能增加。 [2004] Advanced planning, including the development of local protocols for care,should be implemented in obstetric units that deliver babies of women and girls with epilepsy. [2004] 应在为癫痫女性患者接生的产科部门实施先进的计划，包括制定当地的护理规程。 [2004] Although there is an increased risk of seizures in children of parents with epilepsy, children, young people and adults with epilepsy should be given information that the probability that a child will be affected is generally low.However, this will depend on the family history. [2004] 尽管患有癫痫的父母的孩子癫痫发作的风险增加，但应告知癫痫患者（包括儿童、青少年和成人）儿童受影响的可能性通常较低，尽管这将取决于他的家族史。 [2004] Joint epilepsy and obstetric clinics may be convenient for mothers and healthcare professionals but there is insufficient evidence to recommend their routine use. [2004] 联合癫痫和产科诊所可能对母亲们和医疗保健专业人员都很方便，但没有足够的证据推荐其常规使用。 [2004] Parents of new babies or young children should be informed that introducing a few simple safety precautions may significantly reduce the risk of accidents and minimise anxiety. An approaching birth can be an ideal opportunity to review and consider the best and most helpful measures to start to ensure maximum safety for both mother and baby. [2004] 应告知新生儿或幼儿的父母，引入一些简单的安全预防措施可以显着降低事故风险并最大程度地减少焦虑。临近分娩可能是一个理想的机会来回顾和考虑最好和最有帮助的措施，以确保母亲和婴儿的最大安全。 [2004] Information should be given to all parents about safety precautions to be taken when caring for the baby (see appendix D[25]of the full guideline). [2004] 应向所有父母提供有关照顾婴儿时应采取的安全预防措施的信息（参见完整指南的附录 D[25]）。 [2004] Parents should be reassured that the risk of injury to the infant caused by maternal seizure is low. [2004] 应该让父母放心，母亲癫痫发作对婴儿造成伤害的风险很低。 [2004] Discuss with women and girls of childbearing potential (including young girls who are likely to need treatment into their childbearing years), and their parents and/or carers if appropriate, the risk of AEDs causing malformations and possible neurodevelopmental impairments in an unborn child. Assess the risks and benefits of treatment with individual drugs. There are limited data on risks to the unborn child associated with newer drugs. Specifically discuss the risk of continued use of sodium valproate to the unborn child, being aware that higher doses of sodium valproate (more than 800 mg/day) and polytherapy, particularly with sodium valproate, are associated with greater risk.[new2012] 请告知有生育潜力的女性患者（包括可能需要治疗至育龄期的年轻女孩）及她们的父母和/或照料人有关抗癫痫药物（AEDs）对胎儿的致畸和引起神经发育障碍的风险。并请评估使用特定药物治疗的风险与益处。目前新药对胎儿的风险数据较少。请特别讨论持续使用丙戊酸钠对未出生的孩子的风险，注意更高剂量的丙戊酸钠（超过 800 毫克/天）和综合疗法（特别是使用了丙戊酸钠时）可能与更大的风险有关。 nice.org.uk/guidance/cg137

Delivery

What are the risks of obstetric complications in pregnant WWE, including those taking AEDs? 妊娠期WWE（包括服用AEDs者）发生产科并发症的风险 [GRADES OF RECOMMENDATION:B] Healthcare professionals need to be aware of the small but significant increase in obstetric risks to WWE and those exposed to AEDs, and to incorporate this in the counselling of women and the planning of management. 【推荐等级：B】WWE和暴露于AEDs的患者发生产科并发症的风险增加（small but significant），应将这些风险考虑到患者咨询和管理计划中。 https://www.rcog.org.uk/guidance/browse-all-guidance/green-top-guidelines/epilepsy-in-pregnancy-green-top-guideline-no-68/

How should depression be screened for in the postpartum period? 产后如何筛查抑郁症 WWE should be screened for depressive disorder in the puerperium. Mothers should be informed about the symptoms and provided with contact details for any assistance. 在产褥期应对WWE筛查产后抑郁，同时应提供相应的咨询和处理。 https://www.rcog.org.uk/guidance/browse-all-guidance/green-top-guidelines/epilepsy-in-pregnancy-green-top-guideline-no-68/

What is the risk of seizure deterioration postpartum and how can this be minimised? 产后癫痫发作恶化的风险 [GRADES OF RECOMMENDATION:C] WWE and their caregivers need to be aware that although the overall chance of seizures during and immediately after delivery is low, it is relatively higher than during pregnancy. 【推荐等级：C】应告知WWE及其看护者，尽管在分娩期间癫痫发作和产后立即出现癫痫发作的可能性很低，但相对来说还是比妊娠期间高。 WWE should be advised to continue their AEDs postnatally. 建议WWE生产后继续服用AEDs。 Mothers should be well supported in the postnatal period to ensure that triggers of seizure deterioration such as sleep deprivation, stress and pain are minimised. WWE应在产后得到充分的护理，以确保最大程度减少癫痫发作的诱发因素，如睡眠不足、压力和疼痛。 https://www.rcog.org.uk/guidance/browse-all-guidance/green-top-guidelines/epilepsy-in-pregnancy-green-top-guideline-no-68/

What is the most suitable place of delivery for WWE? WWE的分娩 For WWE at risk of peripartum seizures delivery should be in a consultant-led unit with facilities for one-to-one midwifery care and maternal and neonatal resuscitation. 对于在围产期有癫痫发作风险的WWE，应在设施设备齐全的产科单元中分娩。（For WWE at risk of peripartum seizures delivery should be in a consultant-led unit with facilities for one-to-one midwifery care and maternal and neonatal resuscitation.） The decision to use water for analgesia and birth should be made on an individual basis. WWE who are not taking AEDs and who have been seizure free for a significant period may be offered a water birth after discussion with their epilepsy specialist. 应视个人情况决定是否使用水浴分娩和镇痛。在经过专家评估后，未服用AEDs且有相当长一段时间无癫痫发作的患者可提供水浴分娩和镇痛。 https://www.rcog.org.uk/guidance/browse-all-guidance/green-top-guidelines/epilepsy-in-pregnancy-green-top-guideline-no-68/

Postpartum safety advice and strategies should be part of the antenatal and postnatal discussions with the mother alongside breastfeeding, seizure deterioration and AED intake.(Safety strategies include nursing the baby on the floor, using very shallow baby baths, laying the baby down if there is a warning aura, not bathing the baby unaccompanied, wearing identification tags, and avoiding sleep deprivation, and alcohol if prone to myoclonic jerks. Women should ensure that family and friends have knowledge of first aid and emergency contact procedures.) 应在产前和产后与WWE共同讨论产后安全建议和策略、母乳喂养、癫痫恶化的风险和AEDs治疗计划。（安全策略包括在平地上喂养婴儿，使用浅的婴儿浴池，不要在无人陪伴的情况下给婴儿洗澡，佩戴身份标签，避免睡眠剥夺，了解急救和紧急联系程序等。） Postnatal mothers with epilepsy at reasonable risk of seizures should be accommodated in single rooms only when there is provision for continuous observation by a carer, partner or nursing staff. 只有在看护者、伴侣或护理人员可以持续监护的情况下才能允许有癫痫发作风险的WWE在产后入住单人病房。 https://www.rcog.org.uk/guidance/browse-all-guidance/green-top-guidelines/epilepsy-in-pregnancy-green-top-guideline-no-68/

What are the recommended methods of analgesia in labour for WWE? WWE分娩镇痛的推荐方法 Pain relief in labour should be prioritised in WWE, with options including transcutaneous electrical nerve stimulation (TENS), nitrous oxide and oxygen (Entonox®), and regional analgesia. 对于WWE的分娩，应优先考虑分娩镇痛，包括经皮神经电刺激、一氧化二氮和氧气以及区域镇痛（Pain relief in labour should be prioritized in WWE, with options including transcutaneous electrical nerve stimulation (TENS), nitrous oxide and oxygen (Entonox ®), and regional analgesia.）。 [GRADES OF RECOMMENDATION:D] Pethidine should be used with caution in WWE for analgesia in labour. Diamorphine should be used in preference to pethidine.（Pethidine is metabolised to norpethidine, which is known to be epileptogenic when administered in high doses to patients with normal renal function. If general anaesthesia becomes necessary, it is prudent to avoid anaesthetic agents such as pethidine, ketamine and sevoflurane. The first two are known to lower seizure threshold and the third may have epileptogenic potential.） 【推荐等级：D】WWE分娩镇痛时慎用哌替啶，二氢吗啡应优先于哌替啶使用。（哌替啶可被代谢为去甲哌替啶，后者在肾功能正常的患者中可引起癫痫发作（大剂量）。全麻时避免使用哌替啶、氯胺酮和七氟醚等麻醉剂，前两种药物可降低癫痫发作阈值，第三种可致痫。） https://www.rcog.org.uk/guidance/browse-all-guidance/green-top-guidelines/epilepsy-in-pregnancy-green-top-guideline-no-68/

Where required, what dose of antenatal corticosteroids should be given to WWE on enzyme-inducing AEDs? 对于服用酶诱导AEDs的WWE，在需要的情况下，应在产前如何给予皮质类固醇？ [GRADES OF RECOMMENDATION:D] In WWE taking enzyme-inducing AEDs who are at risk of preterm delivery, doubling of the antenatal corticosteroid dose for prophylaxis against respiratory distress syndrome in the newborn is not recommended. 【推荐等级：D】对于有早产风险的服用酶诱导AEDs的WWE，不建议增加产前用于预防新生儿呼吸窘迫综合征的皮质类固醇剂量。 https://www.rcog.org.uk/guidance/browse-all-guidance/green-top-guidelines/epilepsy-in-pregnancy-green-top-guideline-no-68/

What are the effects of AED exposure on the newborn through placental transfer and from breast milk? How should babies of WWE taking AEDs be monitored? 经胎盘和母乳暴露于AEDs会对新生儿产生什么影响？应如何监测暴露于AEDs的新生儿？ [GRADES OF RECOMMENDATION:D] Neonates born to WWE taking AEDs should be monitored for adverse effects associated with AED exposure in utero.(Babies born to mothers taking AEDs may have adverse effects such as lethargy, difficulty in feeding, excessive sedation and withdrawal symptoms with inconsolable crying;serum levels of AEDs in the baby should be checked where appropriate.) 【推荐等级：D】应监测服用AEDs的WWE所生新生儿的不良反应（与宫内暴露于AEDs有关的不良反应）。（可能的不良反应有嗜睡、喂养困难、过度镇静、停药症状和哭闹等；应在适当时候监测新生儿/婴儿血清AEDs水平。） https://www.rcog.org.uk/guidance/browse-all-guidance/green-top-guidelines/epilepsy-in-pregnancy-green-top-guideline-no-68/

What is the optimal timing and mode of delivery for WWE based on seizure control? WWE最佳生产方式和时机是什么？ WWE should be reassured that most will have an uncomplicated labour and delivery. 应告知WWE，多数WWE都可经历顺利的分娩过程（uncomplicated labour and delivery）。 [GRADES OF RECOMMENDATION:D] The diagnosis of epilepsy per se is not an indication for planned caesarean section or induction of labour. 【推荐等级：D】癫痫并不是择期剖腹产或引产的适应症。 https://www.rcog.org.uk/guidance/browse-all-guidance/green-top-guidelines/epilepsy-in-pregnancy-green-top-guideline-no-68/

In the antenatal period, WWE should be regularly assessed for the following: risk factors for seizures, such as sleep deprivation and stress; adherence to AEDs; and seizure type and frequency. 在产前应定期评估WWE以下方面：癫痫发作的危险因素（包括睡眠剥夺和压力等），服用AEDs的依从性，癫痫发作的类型和频率。 If admission is required antenatally, WWE at reasonable risk of seizures should be accommodated in an environment that allows for continuous observation by a carer, partner or nursing staff. 如产前需要住院，应将具有癫痫发作风险的WWE安排在可以进行监测的环境中（accommodated in an environment that allows for continuous observation by a carer, partner or nursing staff）。 https://www.rcog.org.uk/guidance/browse-all-guidance/green-top-guidelines/epilepsy-in-pregnancy-green-top-guideline-no-68/

Is there a need to modify the dose of AED after delivery? 产后是否需要调整AEDs剂量？ If the AED dose was increased in pregnancy, it should be reviewed within 10 days of delivery to avoid postpartum toxicity 如果在妊娠期间增加了AEDs剂量，应在产后10天内逐渐减量以避免产后毒性（it should be reviewed within 10 days of delivery to avoid postpartum toxicity）。 https://www.rcog.org.uk/guidance/browse-all-guidance/green-top-guidelines/epilepsy-in-pregnancy-green-top-guideline-no-68/

When a woman with epilepsy presents in the early stages of labour, a low threshold for admission to the maternity unit should be adopted.During labour, one-to-one midwifery care should be given.Factors predisposing to increased risk of seizures in labour should be reduced as much as possible and there should be a low threshold for epidural anaesthesia. 女性癫痫患者出现分娩征兆时应降低入院标准；产时应给予一对一的助产护理；尽可能减少分娩时癫痫发作的危险因素，同时降低硬膜外麻醉的门槛。 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] The usual oral antiepileptic drug should be continued during labour and in the postnatal period. Every effort should be made to ensure that no doses are missed. In women with epilepsy who are unable to tolerate oral medication, the antiepileptic drug can be given by other routes. D级推荐：产时和产后应继续口服AEDs，保证口服剂量（ensure that no doses are missed）；对于不能耐受口服AEDs的女性癫痫患者，可以通过其他途径给予AEDs。 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

Maternal airway and oxygenation should be maintained at all times. 产时注意保持产妇气道通畅和血氧饱和度。 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

Advice regarding contraception, the need for planning future pregnancies, folic acid requirements and risks associated with AEDs in pregnancy should be offered at the postnatal visit. 应在产后随访中提供有关避孕、计划怀孕、补充叶酸以及AEDs的建议。 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] All infants of women with epilepsy should be offered vitamin K1,1 mg intramuscularly at birth,unless there are contraindications. D级推荐：在没有禁忌证的情况下，所有女性癫痫患者的产儿在出生时都应肌肉注射注射1mg VitK1。 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

After the birth a review of the mother’s AED therapy should be undertaken. 在分娩后应对母亲的AEDs治疗进行回顾总结。 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

All pregnant women with epilepsy should be encouraged to plan ahead before the birth of their child. 建议所有女性癫痫患者在孩子出生之前制定护理计划。 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

Extra support should be available to mothers who have a physical or learning disability. 应对存在肢体或学习障碍的母亲提供额外支持。 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

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