Berlit Sebastian, Tuschy Benjamin, Spaich Saskia, Sütterlin Marc, Schaffelder Regine
Department of Obstetrics and Gynecology, University Medical Center Mannheim, 68167 Mannheim, Germany.
Case Rep Obstet Gynecol. 2012;2012:736024. doi: 10.1155/2012/736024. Epub 2012 Jan 26.
Objective. To present a case of maternal myasthenia gravis in pregnancy and give a systematic review of the literature. Case. We report the case of a 38-year-old parturient with a life-threatening complication of immune-mediated myasthenia gravis shortly after an elective cesarean section on patient's request under spinal anesthesia at 35 + 3 weeks of gestation. The newborn was transferred to the pediatric unit for surveillance and did not show any signs of muscular weakness in the course of time. The mother developed a respiratory insufficiency on the second day postpartum. The myasthenic crisis led to a progressive dyspnoea within minutes, which exacerbated in a secondary generalized seizure with cardiac-circulatory arrest. After successful cardiopulmonary resuscitation, the patient was transferred to intensive care. The interdisciplinary therapeutic approach included ventilatory assistance via endotracheal intubation, parenteral pyridostigmine, azathioprine, and steroids. By interdisciplinary measures, a stable state was regained. Conclusion. Myasthenia gravis especially when associated with pregnancy is a high-risk disease. As this disease predominantly occurs in women of reproductive age, it is important to be aware of this condition in obstetrics and its interdisciplinary diagnostic and therapeutic management.
目的。介绍一例妊娠合并重症肌无力的病例，并对相关文献进行系统综述。病例。我们报告了一名38岁产妇的病例，该产妇在妊娠35 + 3周时因患者要求在脊髓麻醉下进行择期剖宫产术后不久，出现了危及生命的免疫介导性重症肌无力并发症。新生儿被转至儿科病房进行监测，一段时间内未出现任何肌无力迹象。母亲在产后第二天出现呼吸功能不全。重症肌无力危象在数分钟内导致进行性呼吸困难，并在继发全身性癫痫发作伴心循环骤停时加重。成功进行心肺复苏后，患者被转至重症监护室。多学科治疗方法包括经气管插管进行通气辅助、胃肠外给予吡啶斯的明、硫唑嘌呤和类固醇。通过多学科措施，患者恢复了稳定状态。结论。重症肌无力尤其是合并妊娠时是一种高危疾病。由于这种疾病主要发生在育龄妇女中，因此在产科了解这种情况及其多学科诊断和治疗管理非常重要。
