A93
FETAL SEIZURES IN NEWBORN ENCEPHALOPATHY
Keogh JM1, Badawi N2,3, Kurinczuk JJ3, Burton PR3, Jongeling B4, Pemberton PJ4, Stanley FJ3.
1
Hornsby Ku-Ring-Gai Hospital, 2New Childrens Hospital Westmead, 3TVW Telethon Institute for Child Health
Research, 4Princess Margaret Hospital for Children
Aim: To describe the association and significance of fetal seizures in newborn encephalopathy (NE).
Methods: A population-based case control study of moderate and severe NE term newborns was carried out in
metropolitan Western Australia between June 1993 and December 1996.
Results and Key Findings: 276 cases and 564 controls were enrolled in the study. Eight of the case
mothers and none of the control mothers had sought medical advice during the index pregnancy for abnormal
excessive intrauterine seizures which they described at presentation as >fits=. All mothers who described
seizure like activity in their fetuses had babies who experienced newborn seizures with five of the eight
commencing seizures in the first twelve hours. Four of these newborns had cerebral infarcts, and one had
diffuse parenchymal injury. Five of these eight women had pre eclampsia. Two of the children developed
cerebral palsy but the rest are normal at follow up to date.
Data on eight cases with newborn encephalopathy with reported fetal seizures
Antepartum data
Intrapartum data
Neonatal data
Family history of seizures and
intrauterine seizures
Spontaneous vaginal delivery
Loose nuchal cord
Apgars 9 and 10, moderate NE
Seizures at 18 hours
Gestational diabetes
Induced vaginal delivery
Tight nuchal cord
Apgars 3,5 and 7, severe NE
Seizures at 8 hours, cerebral palsy
Antepartum haemorrhage
Gestational diabetes
Pre-eclampsia
Recurrence of Herpes I
Vacuum extraction
Mild shoulder dystocia
Apgars 4,5 and 7, severe NE
Seizures at 4 hours
Viral infection prior to delivery
Spontaneous vaginal delivery
Apgars 8 and 9, moderate NE
Seizures at 12 hours
Pre-eclampsia
Vaginal bleeding at 16 weeks
Spontaneous vaginal delivery
Apgars 5 and 9, moderate NE
Seizures at 30 hours
Congenital renal anomalies
Maternal protracted viral illness ,
pre-eclampsia
Normal antepartum CTG
Emergency
Caesarean
pre eclampsia, no labour
for
Family history of cerebral palsy
and seizures
Pre-eclampsia
Occipito-posterior
Emergency
Caesarean
meconium
for
Family history of seizures
Pre-eclampsia
Maternal pyrexia in labour
Vacuum extraction
Apgars 9 and 10, moderate NE
Seizure on day 6
Large cystic hygroma
Apgars 9 and 10, severeNE
Seizures at 11 hours
Apgars 8 and 9, severe NE
Seizures at birth, cerebral palsy
Conclusion: This study provides the first systematic evidence of the significance of fetal seizures in a
population-based study of encephalopathy. Previous reports of fetal seizures have been largely anecdotal.
Reassuring a woman reporting seizure like activity in her fetus may not be appropriate. The recognition of
abnormal movements by a woman may be followed by newborn seizures which tend to be recurrent and cerebral
palsy may be a long term complication. The diagnosis of fetal seizures places the origin of the neurological
insult, in these cases, firmly in the antepartum period.