Lucot J P, Dufour P, Vinatier D, Tordjeman N, Durant-Réville M, Puech F, Monnier J C
Service de Gynécologie-Obstétrique, CHRU de Lille.
J Gynecol Obstet Biol Reprod (Paris). 1996;25(2):179-85.
Assess obstetrical care in rare cases of pregnant women with myasthenia.
Two personal cases led to a brief recall of the disease process and the literature and an assessment of proposed optimal care.
Both pregnancies were carried to term without aggravation of the myasthenia. According to the data in the literature, pregnancy has a variable effect on myasthenia (1/3 stability, 1/3 improvement, 1/3 aggravation). The risk of decompensation during expulsion is great and the patient's efforts should be limited, although cesarian section is not required (excepting classical surgical indications). Peridural anaesthesia is not required (excepting classical surgical indications). Peridural anaesthesia is recommended because it reduces patient fatigue and facilitates instrumental extraction. Nursing is authorized except in case of severe episodes with a major rise in antibody levels. Pre-eclampsia was reported in only 5 cases: both maternal and fetal risk is high in such cases requiring intensive care. Fetal risks include rare neuro-muscular disease in which prognosis is poor and in 15 to 20% of the cases, neonatal myasthenia.
Myasthenia is an autoimmune disease rarely occurring in young women of childbearing age. Care for pregnant women with myasthenia requires close collaboration between the different specialists.
评估重症肌无力孕妇的罕见病例中的产科护理。
通过两例个人病例简要回顾了疾病过程和相关文献，并对提议的最佳护理进行了评估。
两次妊娠均足月分娩，重症肌无力未加重。根据文献数据，妊娠对重症肌无力的影响各不相同（三分之一病情稳定，三分之一病情改善，三分之一病情加重）。分娩时病情失代偿的风险很大，应限制患者用力，不过剖宫产并非必需（除非有经典手术指征）。硬膜外麻醉并非必需（除非有经典手术指征）。建议采用硬膜外麻醉，因为它可减轻患者疲劳并便于器械助产。除抗体水平大幅升高的严重发作情况外，允许护理。仅报告了5例先兆子痫：此类病例中母婴风险均高，需要重症监护。胎儿风险包括预后较差的罕见神经肌肉疾病，以及15%至20%的病例会出现新生儿重症肌无力。
重症肌无力是一种在育龄年轻女性中罕见的自身免疫性疾病。对重症肌无力孕妇的护理需要不同专科医生之间密切协作。
