Management of labor and delivery in myasthenia gravis: A new protocol

Tsurane, Kotoi; Tanabe, Serabi; Matsuda, Naoyuki; Matsuda, Minako; Takahara, Megumi; Ida, Tsutomu; Kohyama, Akira

doi:10.1111/jog.13922

Cited by 17 publications

(12 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Medications for MG should continue uninterrupted before and throughout labor. Patients should undergo spontaneous vaginal delivery in most cases and epidural labor analgesia should be considered early in patients who are likely to experience fatigue during labor (90). Nitrous oxide is safe to use (85).…”

Section: Mg In Specific Patient Groups the Pregnant Patientmentioning

confidence: 99%

A Practical Approach to Managing Patients With Myasthenia Gravis—Opinions and a Review of the Literature

Farrugia

Goodfellow

2020

Front. Neurol.

View full text Add to dashboard Cite

When the diagnosis of myasthenia gravis (MG) has been secured, the aim of management should be prompt symptom control and the induction of remission or minimal manifestations. Symptom control, with acetylcholinesterase inhibitors such as pyridostigmine, is commonly employed. This may be sufficient in mild disease. There is no single universally accepted treatment regimen. Corticosteroids are the mainstay of immunosuppressive treatment in patients with more than mild MG to induce remission. Immunosuppressive therapies, such as azathioprine are prescribed in addition to but sometimes instead of corticosteroids when background comorbidities preclude or restrict the use of steroids. Rituximab has a role in refractory MG, while plasmapheresis and immunoglobulin therapy are commonly prescribed to treat MG crisis and in some cases of refractory MG. Data from the MGTX trial showed clear evidence that thymectomy is beneficial in patients with acetylcholine receptor (AChR) antibody positive generalized MG, up to the age of 65 years. Minimally invasive thymectomy surgery including robotic-assisted thymectomy surgery has further revolutionized thymectomy and the management of MG. Ocular MG is not life-threatening but can be significantly disabling when diplopia is persistent. There is evidence to support early treatment with corticosteroids when ocular motility is abnormal and fails to respond to symptomatic treatment. Treatment needs to be individualized in the older age-group depending on specific comorbidities. In the younger age-groups, particularly in women, consideration must be given to the potential teratogenicity of certain therapies. Novel therapies are being developed and trialed, including ones that inhibit complement-induced immunological pathways or interfere with antibody-recycling pathways. Fatigue is common in MG and should be duly identified from fatigable weakness and managed with a combination of physical therapy with or without psychological support. MG patients may also develop dysfunctional breathing and the necessary respiratory physiotherapy techniques need to be implemented to alleviate the patient's symptoms of dyspnoea. In this review, we discuss various facets of myasthenia management in adults with ocular Farrugia and Goodfellow Practical Approaches to Myasthenia Management and generalized disease, including some practical approaches and our personal opinions based on our experience.

show abstract

Section: Mg In Specific Patient Groups the Pregnant Patientmentioning

confidence: 99%

A Practical Approach to Managing Patients With Myasthenia Gravis—Opinions and a Review of the Literature

Farrugia

Goodfellow

2020

Front. Neurol.

View full text Add to dashboard Cite

show abstract

“…The data collected from the 32 studies 8 , 11 , 16 , 21 – 46 included in the systematic review as well as our own case series are summarized in Table 2 . The included studies represent a heterogeneous group from 22 different countries with case data collected from 1947 up until 2020.…”

Section: Resultsmentioning

confidence: 99%

Myasthenia gravis in pregnancy: Systematic review and case series

et al. 2022

View full text Add to dashboard Cite

Background Myasthenia gravis is an autoimmune disease which can impact pregnancy. Methods Six databases were systematically searched for studies with at least five subjects reporting pregnancy outcomes for women with myasthenia gravis in pregnancy. Assessment of bias was performed for all included studies. Forty-eight cases from our own centre were also included in the analysis. Results In total, 32 publications met inclusion criteria for systematic review, for a total of 33 unique data sets including 48 cases from our institution. Outcome data was available for 824 pregnancies. Spontaneous vaginal delivery occurred in 56.3% of pregnancies. Overall risk of myasthenia gravis exacerbation was 33.8% with a 6.4% risk of myasthenic crisis in pregnancy and 8.2% postpartum. The incidence risk of transient neonatal myasthenia gravis was 13.0%. Conclusions The current systematic review provides the best estimates of risk currently available to aid in counselling women with myasthenia gravis in pregnancy.

show abstract

“…Finally, the risk of transient neonatal myasthenia gravis in individual studies has ranged from 0% 18,26,36,37,47 to 33.3% 34,39,42 . In our large sample, the overall rate was 89/686 (13.0%).…”

Section: Discussionmentioning

confidence: 99%

Myasthenia Gravis in Pregnancy: Case Series and Systematic Review

Banner¹,

Niles²,

Ryu³

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: Myasthenia gravis (MG) is an autoimmune disease which can affect reproductive-aged women and impact pregnancy outcomes. Objectives: To systematically review pregnancy outcomes for patients with MG. Search Strategy: Ovid MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, PubMed (Non-Medline records), Web of Science, and LILACS databases were systematically searched for pregnancies complicated by MG. Selection Criteria: Human studies of five or more subjects reporting outcomes of MG in pregnancy published in any language. Data Collection and Analysis: Following identification and review of relevant studies, data on study characteristics, MG subtypes, treatment, disease and pregnancy outcomes were extracted. Assessment of bias was performed using the National Institutes of Health Quality Assessment Tool for Case Series. In addition, cases of MG in pregnancy managed at our centre were identified and outcomes included in the analysis. Main Results: In total, 32 publications met inclusion criteria for systematic review, for a total of 33 unique data sets including 48 cases at our institution. In total, outcome data was available for 824 pregnancies complicated by MG. Overall risk of MG exacerbation was 33.8% with a 6.4% risk of myasthenic crisis in pregnancy and 8.2% postpartum. Spontaneous vaginal delivery occurred in 56.3% of pregnancies. The risk of transient neonatal myasthenia gravis (TNMG) was 13.0%. Conclusions: One third of pregnant MG patients will experience an exacerbation with 6.4% and 8.2% experiencing myasthenic crisis in pregnancy and postpartum respectively. More than half of MG patients had a spontaneous vaginal birth. The risk of TNMG is 13%

show abstract

Management of labor and delivery in myasthenia gravis: A new protocol

Cited by 17 publications

References 15 publications

A Practical Approach to Managing Patients With Myasthenia Gravis—Opinions and a Review of the Literature

A Practical Approach to Managing Patients With Myasthenia Gravis—Opinions and a Review of the Literature

Myasthenia gravis in pregnancy: Systematic review and case series

Myasthenia Gravis in Pregnancy: Case Series and Systematic Review

Contact Info

Product

Resources

About