••• Chapter 14^ Management of Medical and Surgical Conditions in Pregnancy^155
❍ How are migraine headaches treated in pregnancy?
Minor headaches can be treated with acetaminophen, more severe headaches with IV hydration and antiemetics.
Triptans may be used safely in pregnancy. Women with frequent headaches may be treated with amitriptyline,
propranolol, or labetalol for prophylaxis.
❍ Does epilepsy improve or worsen during pregnancy?
Epilepsy improves or is stable in 80% of women; however, levels of antiepileptics must be monitored closely in
pregnancy. Because of the increased plasma volume in pregnancy, medication doses often must be adjusted.
❍ Which antepileptic medications are associated with congenital anomalies and what can be done to decrease
the risk?
Phenytoin, carbamazepine, lamotrigine, and phenobarbital increase the rate of congenital anomalies two- to
threefold. Valproate can increase the risk of anomalies four- to eightfold and is associated with decreased cognitive
function. Monotherapy should be used whenever possible to decrease fetal medication exposure.
❍ The risk of stroke is increased by how much in pregnancy?
There is almost a 100-fold increased risk of stroke in pregnancy. 10% develop antepartum, 40% intrapartum, and
50% postpartum.
❍ What is the most common risk factor for stroke in pregnancy?
Some form of hypertensive condition—chronic, gestational, or preeclampsia.
❍ How is multiple sclerosis treated in pregnancy?
Acute attacks may be treated with IV and oral steroids IVIG, exchange transfusion, or immunomodulating agents
may be used. IVIG may be given routinely postpartum to decrease the relapse rate.
❍ How is Bell palsy treated in pregnancy?
Corticosteroids.
❍ Is Bell palsy associated with any adverse pregnancy outcomes?
It is associated with a fivefold increased risk of gestational hypertension.
❍ What is autonomic dysreflexia and which patients are at risk?
It is a large, disordered sympathetic stimulation that occurs with stimuli from structures beneath a spinal cord
lesion that is above T5-6. Women with these lesions should be given an epidural at the start of labor to avoid
development of autonomic dysreflexia.
❍ Selective serotonin reuptake inhibitors are associated with what congenital anomaly?
Fetal cardiac defects.
❍ How is postpartum psychosis treated?
Hospitalization, pharmacologic therapy, and long-term psychiatric follow-up.