Acute Intrapartum Seizure in a Pregnant Woman with Epilepsy Receiving Divalproex: Maternal-Fetal Consequences and Emergency Obstetric Management-A Case Report.

INTRODUCTION

Epilepsy, a prevalent neurological disorder affecting 70 million people globally, necessitates special care for women of reproductive age during pregnancy. Abnormal brain activity causes seizures, atypical behavior, and loss of consciousness. Early and consistent reproductive health guidance is crucial. This case investigates epileptic seizures during delivery in women with a history of epilepsy.

CASE PRESENTATION: A 30-year-old G2P1A0 woman at 31-32 weeks of gestation presented with preterm premature rupture of membranes (PPROM) and a history of epilepsy treated with divalproex sodium since adolescence. The patient had remained seizure-free for 15 years prior to admission. Initial maternal examination and cardiotocography (CTG) findings were reassuring, with ultrasound confirming a live singleton fetus appropriate for gestational age. During labor observation, the patient experienced an intrapartum seizure characterized by confusion and repetitive licking movements, followed by fetal heart rate decelerations on CTG classified as category III, indicating fetal distress. Emergency cesarean section was subsequently performed after intrauterine resuscitation and maternal stabilization. A preterm male neonate weighing 1815 grams was delivered with low initial APGAR scores requiring immediate neonatal resuscitation and neonatal intensive care unit (NICU) admission for respiratory distress syndrome and respiratory failure. Postoperatively, the mother remained hemodynamically stable without recurrent seizures and was discharged in satisfactory condition with continued antiepileptic therapy.

CONCLUSION

Careful multidisciplinary management of epilepsy during pregnancy is essential. Breakthrough seizures during labor may lead to acute fetal compromise and require emergency delivery. Close antenatal, intrapartum, and postpartum monitoring is crucial to optimize maternal and neonatal outcomes.