Myasthenia gravis and pregnancy

ABSTRACT

A 33 years old multigravida lady presented at 8 weeks of gestation for booking, with a history of previous three caesarean sections. In 1995, her first pregnancy ended up in spontaneous abortion. The development of classical symptoms of MG during her second pregnancy and delayed recovery from nondepolarizing muscle relaxant [used for general anaesthesia] led to the suspicion of MG. The neonate also suffered from transient neonatal MG. Later on, she was investigated and found to have raised anticholinesterase receptor antibodies [117 nmol/L], cholinesterase level [4355 micro /L] and serum anti-DNA [3.9 I.V/ml]. Other antibodies including ANA, AMSA and AMA were negative. The treatment for MG started with an anti-cholinesterase agent in a dose of 60 mg daily. Thymectomy was carried out in 1998 for enlarged thymus gland and her symptoms further improved. Thereafter, the dose of anti-cholinesterase drug was reduced to half i.e., 30 mg daily during subsequent three pregnancies. The present pregnancy was supervised intensively by an obstetrician and neurologist. An elective C. section with bilateral tubal ligation was carried out on term under spinal anaesthesia. A male baby weighing 4 kg was delivered with an APGAR scores of eight at one minute and ten at five minutes. The patient continued her normal oral therapy before and after the operation. Her puerperium was uneventful