Pregnancy in Post-splenectomized Myasthenia Gravis: A Case Report

JOURNAL TITLE: Journal of Postgraduate Medicine, Education and Research

Author
1. Vidushi Kulshrestha
2. Nilofar Noor
3. Kandala Aparna Sharma
4. Kallol Kumar Roy
ISSN
2277-8969
DOI
10.5005/jp-journals-10028-1443
Volume
55
Issue
4
Publishing Year
2021
Pages
3
Author Affiliations
    1. Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
    1. Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
    1. Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
    1. Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
  • Article keywords
    Myasthenia crisis, Myasthenia gravis, Pregnancy, Pyridostigmine

    Abstract

    Aim and objective: We aim to emphasize the principles of management of pregnant women with a complex medical condition such as myasthenia gravis. Background: Myasthenia gravis is an autoimmune disorder affecting neuromuscular transmission resulting in fatigable weakness of skeletal muscles. Case description: We report a case of pregnancy with myasthenia gravis with a history of splenectomy. The patient was on oral pyridostigmine and prednisolone, which were continued in pregnancy. The patient received multidisciplinary care involving obstetrician, neurologist, anesthetist, and had an uneventful antenatal course. She had a normal vaginal delivery and her postpartum period was uneventful with neonate not developing any signs of myasthenia. Conclusion: This case highlights the importance of a multidisciplinary approach in managing pregnancy with myasthenia gravis for optimum maternal and neonatal outcomes. The patient should continue the drugs for myasthenia throughout pregnancy. Vaginal delivery is not contraindicated, with preparedness for intubation to tackle myasthenia crisis. Instrumental delivery may be needed for inadequate bearing-down efforts. Neonates should be monitored for 48 hours for transient neonatal myasthenia symptoms and may need pyridostigmine till symptoms resolve. Clinical significance: Autoimmune conditions like myasthenia gravis are not uncommon in women in the reproductive age-group. Hence, obstetricians need to acquaint themselves with the knowledge to ensure early diagnosis and appropriate management for a safe pregnancy outcome.

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