M. Papish, T. Nehrych
Danylo Halytsky Lviv National Medical University
Introduction. The combination of myasthenia gravis (MG) and pregnancy has two important aspects: the reflection of the influence of pregnancy on the course of neurological disease and myasthenia influence on the course of pregnancy.
Aim. To determine the optimal tactics of patients with MG during pregnancy.
Materials and methods. We worked with the clinical research data of previous years, and looked at it in a specific example of a patient that was under our observation, who has been diagnosed with myasthenia for 3 years and now is on the 4th week of pregnancy and is under cytostatic therapy, so that we can choose the correct treatment strategy.
Results. During the study of the cases of the diseases we found a lot of interesting facts, for example, that 47 women who became pregnant after the start of MG, 64 pregnancies ended with the birth of 54 children and 10 abortions. Immunosuppressors were administered when symptoms of MG were not controlled by anticholinesterases. The relapse of the disease was observed in 4 out of 23 (17.0%) asymptomatic patients who were not treated for conception; in patients receiving anticholinesterase therapy, MG symptoms improved in 12 out of 31 pregnancies (39.0%), remaining unchanged at 13 (42.0%), and deteriorated at 6 (19.0%) persons. MG symptoms have worsened after the delivery in 15 out of 54 (28.0%) pregnancies. Anti-acetylcholine antibody detection test was positive in 40 of 47 mothers and 30 out of 54 newborns, 13 were positive and 5 out of 54 (9.0%) showed signs of MG in newborns (NMBs). All affected children were seropositive.
In the article we demonstrated the basic principles of prenatal care of the women with myasthenia, prospective ways of treatment, which in practice have positive influence on the main disease, without causing critical deterioration and without adverse impact on the fetus development.
Conclusions. 1. Myasthenia in women can be well managed through relatively safe and effective treatments without causing harm to the fetus; the pregnancy must be planned during the stabilization of the myasthenic status. 2. Anticholinesterases are the basis of treatment, but inhibitors of cholinesterase may induce preterm labor. If the symptoms of myasthenia do not respond to treatment with anticholinergic agents, corticosteroids that have little or no teratogenic effect on the fetus can be used. Plasmapheresis and intravenous immunoglobulins are successfully used to treat MG crises during the pregnancy. 3. Immunosuppressive therapy (ie azathioprine) should be stopped long before planning the pregnancy, as it may adversely affect the fetus. In the case of unplanned pregnancy, if a woman has taken cytostatics, it is recommended to stop it artificially.
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