gynecology and obstetrics
Autoimmune Disorders in Pregnancy
Myasthenia Gravis in Pregnancy
 Myasthenia Gravis varies in its course during pregnancy and even between pregnancies in the same woman. The diagnosis is made after clinical and physical examination reveals muscle weakness and is confirmed by serum immunoassays of autoantibody levels. Frequent acute myasthenic episodes may require increasing doses of anticholinesterase medications (eg,neostigmine), which may cause symptoms of cholinergic excess (eg, abdominal pain, diarrhea, vomiting, increasing weakness);atropinemay then be required. Sometimes myasthenia becomes refractory to standard therapy and requires corticosteroids or immunosuppressants. During labor, women may need assisted ventilation and are extremely sensitive to medications that depress respiration (eg, sedatives, opioids, magnesium sulfate). Therefore, regional anesthesia is preferred to intravenous medications for pain control during labor and delivery. Because the IgG responsible for myasthenia crosses the placenta, transient myasthenia occurs in 20% of neonates ( Reference ), even more if mothers have not had a thymectomy. Although vaginal delivery is recommended, an assisted vaginal delivery may be required due to weakness of striated muscle. 1.Gamio S, Garcia-Erro M, Vaccarezza MM, Minella JA: Myasthenia gravis in childhood.Binocul Vis Strabismus Q19(4):223-231, 2004. 