Ankylosing spondylitis and motherhood

Østensen, Monika; Romberg, Ø.; Husby, Gunnar

doi:10.1002/art.1780250204

Cited by 76 publications

(47 citation statements)

References 12 publications

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“…Although most pregnancies go to term gestation with vaginal deliveries, pelvic bony involvement in severe cases may hinder the progress of labour, causing dysfunctional labour and increased risk of Cesarean delivery. 11 We strongly recommend an initial trial of labour for parturients with AS, as operative delivery may be technically difficult for both obstetrical and anesthesia-related considerations and may contribute to postoperative cardiopulmonary complications. Nevertheless, an operating room should be prepared for a difficult airway scenario.…”

Section: Discussionmentioning

confidence: 99%

Failed epidural analgesia in a parturient with advanced ankylosing spondylitis: a novel explanation

Hoffman

Zaphiratos

Girard

et al. 2012

Can J Anesth/J Can Anesth

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Purpose Ankylosing spondylitis (AS) is a chronic progressive multisystemic disease. Patients with AS present a specific set of anesthesia-related challenges, and the parturient with AS presents particular anesthetic considerations. We report our experience with a parturient with advanced AS and offer a novel explanation for the high incidence of epidural failures in this patient population. Clinical features We present the case of a 36-yr-old primigravida parturient with a very difficult airway and a history of severe AS. The initial treatment plan was to use a continuous epidural for labour analgesia. Despite two successful placements of lumbar epidural catheters, adequate rostral spread of local anesthesia to control her labour pain was never achieved via the epidural route. Thus, continuous spinal anesthesia was used, which provided effective labour analgesia in this patient. Conclusion We hypothesize that this patient's advanced calcified posterior longitudinal ligament caused a physical barrier to rostral spread of local anesthesia solution within her epidural space. This hypothesis is supported by a recent study highlighting the importance of this ligament in allowing adequate distribution of solution within the epidural space. In addition, the successful use of continuous spinal analgesia adds to the growing body of literature supporting the safety and efficacy of intrathecal catheters for labour analgesia in specific situations. RésuméObjectif La spondylarthrite ankylosante (SpA) est une maladie chronique e´volutive affectant plusieurs syste`mes. Les patients souffrant de SpA posent une se´rie de de´fis spe´cifiques lie´s à l'anesthe´sie et les proble`mes d'une parturiente souffrant de SpA ne´cessitent une approche encore plus e´labore´e. Nous de´crivons notre expe´rience avec une parturiente atteinte de SpA avance´e et proposons une nouvelle explication pour l'incidence e´leve´e d'e´checs de la pe´ridurale dans cette population de patientes. Caractéristiques cliniques Nous pre´sentons le cas d'une parturiente de 36 ans, primipare, ayant des ante´ce´dents de SpA se´ve`re et des voies ae´riennes difficiles. Le plan the´rapeutique initial consistait a`utiliser une pe´ridurale continue pour l'analge´sie au cours du travail. Malgre´la mise en place re´ussie de deux cathe´ters pe´riduraux par voie lombaire, une diffusion rostrale approprie´e de l'anesthe´sie locale pour atte´nuer sa douleur n'a jamais e´teó btenue par voie pe´ridurale. En conse´quence, une

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Section: Discussionmentioning

confidence: 99%

Failed epidural analgesia in a parturient with advanced ankylosing spondylitis: a novel explanation

Hoffman

Zaphiratos

Girard

et al. 2012

Can J Anesth/J Can Anesth

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“…At least half will have some aggravation of symptoms in the postpartum period as well. [20][21][22][23] Studies looking at pregnancy and fetal outcomes appear to show no increase in premature labor, preeclampsia, or adverse fetal outcomes. Six hundred forty-nine women with an average of 2.4 pregnancies per woman (1.4 pregnancies occurring during disease) were assessed for outcomes by questionnaires in the United States, Canada, and Europe.…”

Section: Preconception Counselingmentioning

confidence: 99%

Management of Rheumatic Diseases During Pregnancy

Elliott

Chakravarty

2010

Postgraduate Medicine

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Systemic rheumatic diseases commonly affect women during the childbearing years. Many women with these diseases may be contemplating pregnancy or discover an inadvertent pregnancy, leading to concerns regarding medication use, changes in disease activity during pregnancy, safety of lactation, and future ability to care for a child given the presence of chronic illnesses. There are outstanding reviews that summarize the safety and use of immunosuppressive medications during pregnancy. However, in addition to medication use, providers need to be aware of the available data regarding fertility, pregnancy outcomes, delivery, and lactation issues that may be specific to individual diseases. Optimally, women should plan pregnancies to occur around times of disease quiescence, several months after potentially teratogenic medications have been discontinued. The course of the underlying rheumatic disease during pregnancy is variable, and there are no specific clinical or laboratory variables that consistently predict disease improvement or worsening during pregnancy. Recent data suggest that increased disease activity in women with most autoimmune diseases during pregnancy may lead to increased risk of premature delivery, low-birth-weight infants, and other adverse pregnancy outcomes. Arthritis involving the cervical spine and hips may impact delivery and must be considered by both obstetricians and obstetric anesthesiologists. Data are mixed regarding the impact of breastfeeding on underlying autoimmune diseases; the choice to continue breastfeeding is a personal decision.

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“…Bei 12 der Kinder der AS-Mütter entwickelte sich eine definitive AS [37]. Junge Mütter scheinen ein höheres Risiko zu haben, dass ihre Kinder später an einer AS erkranken [3,22].…”

Section: Schwangerschaftskomplikationenunclassified

Schwangerschaft bei rheumatoider Arthritis oder Spondyloarthritiden

Østensen

2006

Z. Rheumatol.

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The activity of a rheumatic disease can be influenced by pregnancy and puerperium. Prospective studies have shown an improvement in joint involvement in rheumatoid arthritis in two thirds to three quarters of pregnancies. After birth, an exacerbation is common. In spondylarthropathies there is no relevant change in disease activity. The fetal outcome is not impaired in patients with rheumatoid arthritis and inflammatory spondylarthropathies. Every pregnancy in women with a rheumatic disease should be considered as high-risk, and such pregnancies require close collaboration between rheumatologists and obstetricians.

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Ankylosing spondylitis and motherhood

Cited by 76 publications

References 12 publications

Failed epidural analgesia in a parturient with advanced ankylosing spondylitis: a novel explanation

Failed epidural analgesia in a parturient with advanced ankylosing spondylitis: a novel explanation

Management of Rheumatic Diseases During Pregnancy

Schwangerschaft bei rheumatoider Arthritis oder Spondyloarthritiden

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