Скачать или смотреть Epilepsy in Pregnancy | USMLE Step 2 CK | High-Yield OB-Neuro Integration for Clinical Practice

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Epilepsy in Pregnancy | USMLE Step 2 CK | High-Yield OB-Neuro Integration for Clinical Practice

This high-yield USMLE Step 2 CK lecture focuses on the management of epilepsy in pregnancy, a critical topic that sits at the intersection of neurology and obstetrics. Epilepsy affects approximately 0.5 to 1 percent of pregnant women in the United States, and balancing seizure control with fetal safety is vital for maternal and neonatal outcomes. This session covers how to approach epilepsy before conception, throughout pregnancy, during labor and delivery, and in the postpartum period — all of which are commonly tested on Step 2 CK.

We begin by reviewing how pregnancy alters antiepileptic drug (AED) pharmacokinetics through increased volume of distribution, hepatic enzyme induction, and renal clearance — leading to lower serum drug levels and a potential for breakthrough seizures. Step 2 CK–style clinical vignettes often test the importance of monitoring AED levels regularly during pregnancy and adjusting doses accordingly.

We emphasize the teratogenic risks of antiepileptic medications, with valproate carrying the highest risk of neural tube defects, cardiac malformations, and cognitive delay. Safer alternatives include lamotrigine and levetiracetam, which are preferred in pregnancy. Step 2 CK questions may ask for the most appropriate seizure medication for a woman planning pregnancy, and the correct answer typically favors medications with lower teratogenic risk and well-established safety profiles.

Preconception planning should include switching to a safer AED if needed, folic acid supplementation (4–5 mg/day), and patient education. During pregnancy, seizure control remains the top priority, as generalized tonic-clonic seizures can lead to fetal hypoxia, trauma, and miscarriage. Intrapartum and postpartum considerations include the increased risk of seizure recurrence, drug level fluctuations, and safety during breastfeeding.

We also cover the management of status epilepticus in pregnancy, which is a neurologic emergency requiring benzodiazepines followed by second-line agents like levetiracetam or fosphenytoin, while closely monitoring maternal hemodynamics and fetal status.

This lecture equips you with a clear, evidence-based approach to answering Step 2 CK questions on epilepsy in pregnancy, with a focus on medication safety, dose monitoring, fetal risk, and maternal neurologic stability.


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