Neurologic Disorders in Pregnancy

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Neurologic diseases are not common among pregnant women, yet once a pregnant woman has a seizure disorder, she must be carefully monitored as this condition might deprive the fetus of oxygen.

Learn the nursing care of a woman with neurologic disorders: seizure disorder, myasthenia gravis, and multiple sclerosis.

Seizure Disorder

  • The cause of most recurrent seizures is idiopathic, yet there are some which are caused by head trauma or meningitis.
  • There are no contraindications to pregnancy for women with seizures as long as medication is taken at the lowest dose possible and serum levels are carefully monitored.
  • In the early months of pregnancy, remind the woman to continue taking her anti-seizure medications approved by both her obstetrician and primary care provider.
  • The risk of adverse maternal or fetal outcome from seizures during pregnancy is greater than the risk of teratogenicity from taking anticonvulsant medications.
  • Some of the common drugs prescribed to control seizures are trimethadione, valproic acid, carbamazepine, and phenytoin sodium.
  • With decreased levels of vitamin K coagulation factors due to phenytoin, an infant may be prone to hemorrhagic disease.
  • Women should be prescribed with vitamin K during labor or for the last 4 weeks of gestation.

Myasthenia Gravis

  • Myasthenia gravis is an autoimmune disorder characterized by the presence of IgG antibody against acetylcholine receptors in striated muscle, causing the muscle not to contract particularly those in the oropharyngeal, facial, and extraocular groups.
  • Drugs prescribed are Mestinon or Prostigmin, and may be continued during pregnancy as there are no effects on the fetus.
  • To reduce symptoms, plasmapheresis or removal of and replacement of plasma could be performed to remove immune complexes from the blood stream.
  • Magnesium sulfate should be avoided because it diminishes the acetylcholine effect and increases the symptoms.
  • Labor should occur normally as smooth muscles are not affected by the disease.
  • The infant may demonstrate symptoms of the disease at birth because of the transfer of antibodies.

Multiple Sclerosis

  • MS refers to nerve fibers that become demyelinated and lose their function.
  • Symptoms include fatigue, numbness, blurred vision, and loss of coordination.
  • ACTH is given to strengthen nerve conduction and is safe during pregnancy.
  • Women may continue with plasmapheresis during pregnancy as long as the volume of exchange is controlled.
  • Pregnancy does not affect the long-term cause of MS.
  • MS may actually improve due to the increase in circulating corticosteroid levels.

Practice Quiz: Neurologic Disorders in a Pregnant Woman


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Quiz


1. Why is cesarean birth necessary in women who have appendicitis?

A. To avoid inflaming the appendix even more.
B. To provide a more safe delivery option for the mother.
C. To avoid the rupture of the appendix and remove the inflamed appendix afterward.
D. To avoid more blood loss during birth.

2. How is GERD diagnosed?

A. Laparoscopy
B. Direct endoscopy
C. Ultrasound
D. Both B and C

3. What is the mode of transmission of Hepa B?

A. Exposure to contaminated blood or blood products and body secretions.
B. Fecal-oral transmission
C. Ingestion of fecally contaminated water or shellfish
D. Direct contact

4. How could an infant with a mother affected with seizure disorder acquire hemorrhagic disease?

A. Through the drugs that the mother is taking.
B. Through trauma from seizure episodes of the mother.
C. Through a decrease in the vitamin K coagulation factors due to phenytoin
D. Through an increase in vitamin K production

5. Plasmapheresis is done to women with MS and MG because:

A. It removes and replaces plasma to remove the immune complexes from the blood stream.
B. It strengthens nerve conduction.
C. It increases the level of circulating corticosteroids.
D. It diminishes the acetylcholine effect.

Answers and Rationale


1. Answer: C. To avoid the rupture of the appendix and remove the inflamed appendix afterward.

C: Cesarean birth could avoid the rupture of the inflamed appendix because the woman needs not to bear down and apply pressure as with normal delivery.
A: Performing a cesarean birth does not guarantee that inflammation would subside.
B: Cesarean birth is the only option for a safe delivery to avoid the rupture.
D: More blood loss is associated with cesarean birth than normal delivery.

2. Answer: D. Both B and C

D: Either direct endoscopy or ultrasound can be used to diagnose the occurrence of GERD in a pregnant woman.
A: Laparoscopy is inappropriate as the affected part can be examined only by endoscopy.

3. Answer: A. Exposure to contaminated blood or blood products and body secretions.

A: Hepa B is acquired through exposure of the pregnant woman to contaminated blood or blood products and body secretions.
B: Fecal-oral transmission is the mode of transmission of Hepa A.
C: Ingestion of fecally contaminated water or shellfish is the mode of transmission of Hepa A.
D: Direct contact is not a part of transmission of hepatitis.

4. Answer: C. Through a decrease in the vitamin K coagulation factors due to phenytoin

C: Phenytoin causes decrease in vitamin K coagulation factors which could lead the infant to acquire hemorrhagic disease.
A: Maintenance drugs of the woman should be continued during pregnancy because they do not affect the fetus as long as they are approved by the obstetrician and the primary care provider.
B: Trauma could not cause direct injury to the fetus inside the woman.
D: A decrease and not an increase in vitamin K happens.

5. Answer: A. It removes and replaces plasma to remove the immune complexes from the blood stream.

A: Plasmapheresis mainly removes and replaces plasma among women who have MG and MS during pregnancy.
B: It cannot strengthen nerve conduction.
C: MS improves with pregnancy as it increases the level of circulating corticosteroids.
D: Magnesium sulfate is responsible for diminishing the effect of acetylcholine in MG.

Disease conditions may be quite inevitable for some women, yet all they need are the guidance of their healthcare providers and the assurance that all would go well if they have enough compliance. Nurses safeguard the health of every person in every stage and situation, from womb to tomb.

Marianne is a staff nurse during the day and a Nurseslabs writer at night. She is a registered nurse since 2015 and is currently working in a regional tertiary hospital and is finishing her Master's in Nursing this June. As an outpatient department nurse, she is a seasoned nurse in providing health teachings to her patients making her also an excellent study guide writer for student nurses. Marianne is also a mom of a toddler going through the terrible twos and her free time is spent on reading books!

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