Childbirth in women with epilepsy: anesthesiological aspects

Objective. To evaluate the efficacy and safety of different methods of labor analgesia in women with epilepsy. Materials and Methods. A prospective observational study was conducted involving 313 women with epilepsy who delivered vaginally between 2017 and 2024. Patients were divided into groups according to disease activity (active epilepsy, medication-induced remission, and drug-free remission lasting more than 5 years). For pain relief during vaginal delivery (n=313), pharmacological analgesia (PA), epidural analgesia (EA), and their combination (EA+PA) were used. Analgesic efficacy was assessed using changes in pain intensity on the Visual Analog Scale (VAS) and levels of biochemical stress markers (salivary α-amylase and substance P). Results. The combined method (EA+PA) demonstrated the highest efficacy: 60—90 minutes after initiation of analgesia, VAS pain scores decreased by 47—54%, while stress marker levels decreased by 24—60%. In patients with active epilepsy and high anxiety levels, this method provided the most stable analgesic effect. When epidural analgesia was used alone, pain intensity increased by the end of labor and returned to levels comparable to baseline values. Conclusion. Combined labor analgesia (EA+PA) is the most effective method for spontaneous vaginal delivery in women with epilepsy, particularly in nulliparous women with active disease. Management of these patients requires a multidisciplinary approach and individualized anesthetic care, taking into account their psycho-emotional status.