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8IAg. Contraceptive advice for patients with epilepsy declined
8IB2. Contraceptive advice for patients with epilepsy not indicated
8IAh. Pre-conception advice for patients with epilepsy declined
8IB3. Pre-conception advice for patients with epilepsy not indicated
8IAi. Pregnancy advice for patients with epilepsy declined
8IB4. Pregnancy advice for patients with epilepsy not indicated
7E10. Bilateral excision of adnexa of uterus
7E100 Bilateral salpingoophorectomy
7E101 Bilateral salpingectomy NEC
7E102 Bilateral oophorectomy NEC
7E10y Other specified bilateral excision of adnexa of uterus
7E10z Bilateral excision of adnexa of uterus NOS
7E111 Salpingoophorectomy of remaining solitary fallopian tube and ovary
7E113 Salpingectomy of remaining solitary fallopian tube NEC
7E115 Oophorectomy of remaining solitary ovary NEC
7E15. Open bilateral occlusion of fallopian tubes
7E150 Open bilateral ligation of fallopian tubes
7E151 Open bilateral clipping of fallopian tubes
7E15y Other specified open bilateral occlusion of fallopian tubes
7E15z Open bilateral occlusion of fallopian tubes NOS
7E160 Open ligation of remaining solitary fallopian tube
7E162 Open clipping of remaining solitary fallopian tube
7E1C. Endoscopic bilateral occlusion of fallopian tubes
7E1C3 Endoscopic bilateral placement of intrafallopian implants
7E1D0 Endoscopic occlusion of remaining solitary fallopian tube
159A. H/O: tubal ligation
ZV25x [V]Other sterilisation
ZV252 [V]Sterilisation
F1321 Progressive myoclonic epilepsy
SC200 Traumatic epileps
dn...% CONTROL OF EPILEPSY
d26..% CLOBAZAM (v16)
It is estimated that in the UK 131,000 women with epilepsy are of child bearing age (12 – 50 years). Approximately 25 per cent of all people with epilepsy are women of reproductive age and 1 in 200 women attending antenatal clinics are receiving antiepileptic drugs (AEDs)47. Around 2500 women with epilepsy will have a baby each year in the UK.
Antiepileptic drugs taken during pregnancy are associated with an increased risk of major congenital malformations (MCMs). Women in the general population have a one to two per cent chance of having a baby with an MCM. Women with epilepsy taking one AED have a chance of having a baby with an MCM of slightly over 3.5 per cent, while for women taking two or more AEDs the average chance increases to 6 per cent48. The risk of MCMs occurring can relate to having epilepsy and to taking AEDs while pregnant.
In a survey of women with epilepsy, only 28 per cent of participants aged 19 – 34 years have received information about oral contraception and epilepsy medication49. In the same group, 71 per cent said that the risk of epilepsy and/or an AED affecting the unborn child is an important issue. Only 46 per cent of women with epilepsy who have had children had been told before conceiving or during pregnancy that their medication might affect their unborn child.
NICE clinical guideline 20 on epilepsy made the following recommendation as a key priority for implementation:
Women with epilepsy and their partners, as appropriate, must be given accurate information and counseling about contraception, conception, pregnancy, caring for children, breastfeeding and menopause.
SIGN clinical guideline 70 on epilepsy states:
Advice on contraception should be given before young women are sexually active. Women with epilepsy should be advised to plan their pregnancies.
Clinicians should use their judgment as well as the evidence base presented in this guidance to ensure that appropriate advice is given and is tailored to the women’s individual needs. Not all three pieces of advice (contraception, conception and pregnancy) need to be given at the same time but may be given separately at any point over the15 month period.
Advice must be given in the context of a face to face consultation.
The practice reports the percentage of women on the epilepsy register from 18 to 55 years who have been given information and advice in the preceding 15 months for contraception, conception and pregnancy (unless not clinically necessary e.g. post hysterectomy and early menopause).
Practices are required to deliver all three pieces of advice as outlined in this indicator in order for the patient to be included in the target. Where one or more of these elements of advice are not clinically appropriate for example if the patient is already pregnant then normal exception reporting rules apply.
Practices should demonstrate how patients are given such advice e.g. provide examples of leaflets and any specific practice protocols. Evidence that the advice has been given in the context of a face to face consultation can be demonstrated by a print out or summary of appointment bookings.
47 Royal Society of Medicine (2004). Primary
care guidelines for the management of females with epilepsy.
www.rsmpress.co.uk/epilepsy_web.pdf
48 Morrow J, Russell A, Guthrie E et al. (2006) Malformation risks of antiepileptic drugs in pregnancy: a prospective study from the UK Epilepsy and Pregnancy Register. Journal of Neurology, Neurosurgery and Psychiatry 77: 193–8
49 Crawford P, Hudson S (2003) Understanding the information needs of women with epilepsy at different lifestages: results of the 'Ideal World' survey. Seizure 12: 502–7
Prepared By Jean Keenan