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///2018 Abstract Details
2018 Abstract Details2019-08-02T15:57:01-05:00

Myasthenia Gravis During Pregnancy

Abstract Number: T3D-2
Abstract Type: Case Report/Case Series

Jie Zhou MD, MS, MBA1 ; Emily Siu MD2; Minxian Liang MD3

Background:

Myasthenia gravis (MG) is a chronic autoimmune neuromuscular disease that occurs more commonly in females, and typically presents during the childbearing years. Therefore, the presence and management of MG during pregnancy poses unique challenges to anesthesiologists and obstetricians. In 2016, the MG Foundation of America published guidelines for the management of MG, including a treatment guide for caring for patients with MG during pregnancy. However, the course of MG is highly variable and it is unclear if any one treatment is best. There are no predictors to determine which parturients will develop exacerbations, and treatment decisions are complex, given the potential complications for the fetus, patient and integrity of the pregnancy. Identifying the patterns and issues that arise in the course of MG during pregnancy and delivery can help to decrease risks to the patient and fetus and advance outcomes. The objective of this study was to evaluate the impact and outcome of pregnancy in women with a history of MG.

Methods:

Clinical data of parturients with MG from Brigham and Women’s Hospital between 1995-2017 were retrospectively reviewed and analyzed.

Results:

A total of 21 women experienced 31 pregnancies in this cohort. The average age of MG diagnosis was 25 years. 6 pregnancies occurred an average of 2.7 years before the diagnosis of MG. 25 pregnancies occurred an average of 10.5 years after the MG diagnosis. 10 cases of MG during pregnancy were treated with pyridostigmine. 6 were treated with prednisone. 5 patients had worsening of symptoms during pregnancy. 2 patients had medication doses increased. There were 17 vaginal and 12 cesarean deliveries, 1 assisted vaginal delivery and 3 cesarean deliveries for failure to progress. The most common anesthetic technique was epidural (67.7%). There was 1 intrauterine fetal death at 37 weeks. The average Apgar index in patients with MG before pregnancy was lower than that of patients with MG after pregnancy.

Discussion:

Our data suggest that labor anesthesia is safe in parturients with MG. Patients that experience MG exacerbations should be monitored closely and may need medication adjustments, especially those with exacerbations in the later stages of pregnancy and postpartum.

References:

1. Hassan A, Sultan Qaboos Univ Med J 2017.

2. Sanders DB, Neurology 2016.

3. Chaudhry SA, Can Fam Physician 2012.

4. Massey JM, Neurol Preg 2014.

5. Neves AR, BMJ Case Rep 2015.



SOAP 2018