Patra Anil Kumar, Das Marami, Choudhury Saswati Sanyal, Goswami Munindra, Vanlalzami K
Department of Neurology, Gauhati Medical College and Hospital, Guwahati, Assam, India.
Department of Obstetrics and Gynaecology, Gauhati Medical College and Hospital, Guwahati, Assam, India.
Ann Indian Acad Neurol. 2022 May-Jun;25(3):417-421. doi: 10.4103/aian.aian_362_22. Epub 2022 Jun 21.
Guillain-Barré Syndrome (GBS) is an acute, autoimmune disorder of the peripheral nervous system triggered by a bacterial or viral infection or other antecedent events. Modern day critical care has dramatically improved the outcome of GBS. GBS during pregnancy is rare with an annual incidence of 2.8/100,000 population. Pregnancy itself is a life-threatening condition and full of complications. GBS during pregnancy makes its more complicated in terms of both maternal and fetal care during peripartum period.
This was a prospective study conducted by the Department of Neurology, Gauhati Medical College including 36 patients of GBS presenting during peripartum period in between December 2019 and November 2021. Their clinical and electrophysiological features were analyzed. Hughes grading, EGRIS, mEGOS, MRC sum score were used. The fetal outcome was observed and patients were followed up for GBS outcome at 3 months and 6 months.
The mean age of patients was 25.97 years. AIDP was the most common subtype found in 21 (58.33%) patients followed by AMAN in 7 (19.4%), AMSAN in 3 (8.33%). In 3 cases NCS was equivocal and in 3 cases inexcitable. Respiratory distress was found in 13 (36.1%) cases, out of which 4 (11.1%) required mechanical ventilation and 1 (2.8%) died. The pre-term birth rate and stillbirth rate were 35.7% (n = 10) and 8.33% (n = 3), respectively with 66.7% (n = 24) spontaneous vaginal delivery(SVD). At 3 month 26 (72.2%) had complete recovery. 5 (13.9%) and 4 (11.1%) had partial and poor recovery, respectively. 78.9% of primigravidae had complete recovery in comparison to 64.7% in multigravidae indicating better outcome in primigravidae in this study.
The outcome of GBS during peripartum period is favorable. Primigravidae are more commonly affected but have better outcome than the multigravidae. The risk of developing GBS in pregnancy decreases significantly after delivery and is minimal after 2 weeks. GBS is not an indication for LSCS. Stillbirth rate and preterm birth rate is higher in pregnancy associated with GBS without fearsome neonatal complications.
吉兰-巴雷综合征（GBS）是一种由细菌或病毒感染或其他先前事件引发的急性自身免疫性周围神经系统疾病。现代重症监护显著改善了GBS的预后。孕期GBS较为罕见，年发病率为2.8/100,000人口。妊娠本身就是一种危及生命的状况，且并发症众多。孕期GBS在围产期的母婴护理方面使其更为复杂。
这是一项由高哈蒂医学院神经科进行的前瞻性研究，纳入了2019年12月至2021年11月期间围产期出现GBS的36例患者。分析了他们的临床和电生理特征。采用了休斯分级、EGRIS、mEGOS、MRC总分评分。观察了胎儿结局，并对患者进行了3个月和6个月的GBS预后随访。
患者的平均年龄为25.97岁。最常见的亚型是急性炎症性脱髓鞘性多发性神经病（AIDP），21例（58.33%）患者为该型，其次是急性运动轴索性神经病（AMAN）7例（19.4%），急性运动感觉轴索性神经病（AMSAN）3例（8.33%）。3例患者的神经传导速度检查结果不明确，3例患者的神经无兴奋性。13例（36.1%）患者出现呼吸窘迫，其中4例（11.1%）需要机械通气，1例（2.8%）死亡。早产率和死产率分别为35.7%（n = 10）和8.33%（n = 3），66.7%（n = 24）为自然阴道分娩（SVD）。3个月时，26例（72.2%）患者完全恢复。5例（13.9%）和4例（11.1%）患者分别部分恢复和恢复不佳。初产妇中有78.9%完全恢复，经产妇中这一比例为64.7%，表明本研究中初产妇的预后更好。
围产期GBS的预后良好。初产妇更易受影响，但预后比经产妇更好。妊娠期间发生GBS的风险在分娩后显著降低，2周后降至最低。GBS并非剖宫产的指征。与GBS相关的妊娠中死产率和早产率较高，但无可怕的新生儿并发症。
