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Neurological Outcomes in Women with Multiple Sclerosis undergoing Pain Relief in Childbirth: A Cross Sectional Study of Patients Delivering at Mount Sinai Hospital from 2000 to 2013.
Abstract Number: S-39
Abstract Type: Original Research
Introduction: The effect of neuraxial anesthesia on the post-partum relapse rate in women with Multiple Sclerosis(MS)remains controversial,given the paucity of literature on this topic (1). Anesthesiologist are divided on the use of neuraxial analgesia for MS patients(2) because of the possibility of exacerbating preexisting disease. We aimed to identify the correlation between the use of labor analgesia/anesthesia and neurological outcomes in parturients with MS.
Methods: This was a cross sectional study. Eligible women were those who had MS and had delivered at the Mount Sinai Hospital from 2000-2013. Subjects were identified from the Medical Records and Special Pregnancy Program databases. Eligible women were contacted by phone and informed about the study, and those agreeing to participate were asked to sign an informed consent which was mailed. The steps in the study were as follows: 1) a chart review to look at obstetric and anesthesia data; 2) a mailed structured questionnaire inquiring about their MS and relapse(s) in the year preceding a given pregnancy, during pregnancy, and during the first 2 years postpartum; and 3) a follow-up telephone call to determine the degree of disability, if any, using the Expanded Disability Status Scale(3).
Results: 94 women were identified for a total number of 112 pregnancies. 8 women declined, 27 could not be reached. 59 (62.8 %) women consented for a total of 75 pregnancies. Mean age was 34.1 ± 6.4 years. The number of times each patient was able to conceive ranged from 1 -7 (mean 2). Average gestational age was 38 ± 2.6 weeks. The most common mode of delivery was spontaneous vaginal delivery (37.1%) followed by elective CS (27.4%), emergency CS (25.8%) and assisted vaginal delivery (9.7%). Epidural analgesia (67.7%) was the most common choice of analgesia for delivery. The other choices were spinal (19.4%), combined spinal/epidural (3.2%), general anesthesia (3.2%), patient controlled intravenous analgesia (1.6%) and no analgesia (4.8%).
Discussion: Preliminary analysis suggests a trend in increased CS rate (53%) and use of general anesthesia(3.2%) in this cohort as compared to historical controls at our hospital(34% and <1% respectively). Data on neurological outcomes are being finalized and will be presented at the annual meeting.
References: 1) Can J Anesth 2005;52:454-458; 2) Can J Anesth 2005; 52: 493-7; 3) Neurology 1983, 33:1444-1452.