Intensive care management of Guillain-Barré syndrome during pregnancy

Abstract

A particularly severe case of Guillain-Barré syndrome occurring during pregnancy is reported. The therapeutic approach including plasmapheresis, ventilation, analgesia, sedation, metabolic requirements and heparin therapy is discussed with the consequences on foetal development and the early days of life.

Weakness in pregnancy – expect the unexpected

“…8 In cases requiring ventilatory support in pregnancy, the risk of premature birth has been noted to be greatly increased. 7 Thromboprophylaxis is indicated given hypercoagulability of pregnancy and immobility.…”

Pregnancy, anaesthesia and Guillain Barré syndrome

“…It requires the availability of specialised equipment and staff trained in the technique. In pregnancy, it should be reserved for severe cases but has been used [3,5,7]. Plasmapheresis has no effect on fetal development.…”

“…Distress was caused by failure to appreciate that sensation was still intact and by the physical discomfort of the enlarged uterus in a paralysed patient [16]. Lumbar backache has been helped by the use of epidural morphine [5] but frequent turning is still required to prevent pressure sores and aortocaval compression.…”

“…Despite this and despite severe disease, a healthy fetus was carried to term. In other severe cases, fetal development has also been noted to be normal [3,5]. Normal fetal activity has been noted even at times of maximum maternal paralysis [16].…”

“…Normal fetal activity has been noted even at times of maximum maternal paralysis [16]. In cases in which ventilatory support is required later on in pregnancy, the risk of premature birth has been noted to be greatly increased [3,5].…”