Cavan/Monaghan maternity service implementing recommendations on care of women with epilepsy

A number of non-compliances with the national practice guide for management of women with epilepsy (WWE) in maternity services were found during an audit at Cavan and Monaghan Hospital (CMH).

The HSE Internal Audit report, dated 6 December 2022, found the level of compliance with the practice guide was unsatisfactory.

The healthcare records of all WWE who were pregnant and presented to the maternity service in the 18 months prior to the audit were reviewed (n=13).

The audit found all booking appointments with a midwife took place in the first trimester. However, only one woman with epilepsy had her first appointment with a consultant obstetrician in the first trimester and the remaining 12 in the second trimester.

Birth plans outlining the women’s wishes for labour and the immediate post-partum period were “not evident” and there was only one written prescription for intravenous or buccal medication for use if the WWE had a seizure while in hospital.

In 12 of the 13 healthcare records the woman’s history of epilepsy was recorded in the medical notes. A ‘no pethidine’ instruction was recorded in only two of those 12 healthcare records (the practice guide advises clinicians to avoid the use of pethidine for pain relief as when metabolised it can convert to norpethidine which may be pro-convulsive). In the remaining healthcare record, the midwifery notes recorded a history of epilepsy, but the medical notes did not reference this history. Furthermore, there was no record of a history of epilepsy in the post-natal midwifery notes of four WWE.

Eleven of the 13 WWE had attended a neurology centre in the past and there was evidence they had been advised to self-refer back to their centre for pregnancy care/advice, if they had not already done so. One woman with epilepsy self-referred and two WWE were referred by CMH. It was not possible to establish if the remaining eight WWE had accessed a neurology service in the antenatal period as there was no documented evidence of attendance in the relevant healthcare records.

Maternity staff had established who was supporting all of the WWE on their return home. However, none of the referral letters to the public health nurse made any reference to a history of epilepsy, according to the audit report.  

A spokesperson for RCSI Hospitals told the Medical Independent that five of the seven recommendations arising from the audit had been implemented. Implementation of the other two recommendations was at an advanced stage and would be closed “imminently”.