Camus M, Clouard C
Service de Gynécologie et d'Obstétrique, CHU Pitié-Salpêtrière, Paris.
J Gynecol Obstet Biol Reprod (Paris). 1989;18(7):905-11.
In 10 years we dealt with 8 cases of pregnancy in myasthenic women. Pregnancy does not seem to cause myasthenia to develop. Worsening of the condition, which we found in 40% of our cases, occurs particularly in the first trimester and nearly always regresses. Another critical period is after delivery. Deaths are not unusual in the literature but we did not have to record one in our study. Because myasthenia evolves in different ways it is important to watch these cases carefully and as soon as the diagnosis has been made stabilising treatment is needed. The patient has to be watched for at least two months after the delivery. During the pregnancy the first line of treatment is to use anticholinesterases which do not have any teratogenic effects. In our study all the women carried their pregnancies to term; although in the literature 10-40% of deliveries were premature. This fact makes one consider whether there is an oxytocic effect of anti-cholinesterases. If the mother becomes very tired she should have very little expulsive effort to carry out. Forceps delivery, which is often necessary, is helped if an epidural anaesthetic is given. Breast feeding by the mother can only be carried out if the myasthenia is stable and if there are weak levels of anti-receptor antibodies to acetylcholine. 50% of the newborn are often small for dates and show transitory myasthenia after delivery. The literature, however, shows only 10-20%. This finding is not always correlated with the levels of anti-receptor antibodies for acetylcholine. If they are present, they are useful to diagnose transitory myasthenia.(ABSTRACT TRUNCATED AT 250 WORDS)
在过去10年里，我们诊治了8例重症肌无力女性患者的妊娠情况。妊娠似乎并不会导致重症肌无力病情发展。我们发现40%的病例病情会加重，尤其在孕早期，且几乎总会缓解。另一个关键时期是产后。文献中死亡病例并不少见，但我们的研究中未记录到此类情况。由于重症肌无力病情发展各异，因此仔细观察这些病例很重要，一旦确诊就需要进行稳定病情的治疗。产后至少要对患者观察两个月。孕期的一线治疗是使用无致畸作用的抗胆碱酯酶药物。在我们的研究中，所有女性均足月分娩；而文献中10 - 40%的分娩为早产。这一事实让人思考抗胆碱酯酶药物是否有催产作用。如果母亲非常疲惫，她进行娩出用力时应尽量减小力度。如果给予硬膜外麻醉，通常必要的产钳助产会更顺利。只有在重症肌无力病情稳定且抗乙酰胆碱受体抗体水平较低时，母亲才可以进行母乳喂养。50%的新生儿往往小于孕周，且产后会出现短暂性重症肌无力。然而，文献显示这一比例仅为10 - 20%。这一发现并不总是与抗乙酰胆碱受体抗体水平相关。如果存在这些抗体，它们有助于诊断短暂性重症肌无力。（摘要截选至250词）
