Obstetric anesthesia/analgesia does not affect disease course in multiple sclerosis: 10‐year retrospective cohort study

Abstract

ObjectivesMultiple sclerosis (MS) often occurs in young women and the effect of obstetric anesthesia/analgesia on the disease is poorly understood. No previous study has investigated the course of the disease in women in labor in the Czech Republic. The aim of this study was to evaluate the occurrence or absence of relapses in the 6‐month postpartum period in MS parturients with and without obstetric anesthesia/analgesia.Materials and MethodsWe retrospectively studied all deliveries (n = 58,455) at the University Hospital Brno from 2004 to 2013 and identified those of the women with an ICD‐10 code G35 (MS) recorded anytime in their medical history (n = 428). We included only deliveries of women with confirmed diagnosis at the time of labor (n = 70). Statistical analysis was performed using the Fischer Exact Test.ResultsThere were 70 deliveries of 65 women, including 45 vaginal deliveries and 25 Cesarean deliveries (16 under general anesthesia, 8 with epidural anesthesia and 1 with spinal anesthesia). Epidural obstetric analgesia was performed in 11 deliveries. There was no statistically significant difference in relapses between the vaginal delivery group (n = 15; 33%) and Cesarean section group (n = 10; 40%), p = 0.611.ConclusionNeither delivery mode (vaginal vs Caesarean) nor type of obstetric anesthesia/analgesia was found to have any impact on the course of MS at 6 months postpartum in women with this condition.

Total Hip Arthroplasty in Multiple Sclerosis

“…This could also be transferred to MS patients with THA under general anesthesia. From the field of obstetrics, there is evidence that regional and spinal anaesthesia can be used as successfully as general anaesthesia in existing MS without increasing the risk of postoperative worsening of MS symptoms [23,24]. Since the local anaesthetics used in regional and spinal anaesthesia forms share physiological properties such as the antiexcitatory effect with the pentapeptides that are increased in cerebrospinal fluid in MS, the occurrence of MS symptoms, especially in spinal anaesthesia, is theoretically possible [25].…”

Pregnancy complicated by neurological and neurosurgical conditions – The evidence regarding mode of delivery

“…Two studies totalling 419 deliveries in women with multiple sclerosis (MS) (239 VD – 57%), and with neuraxial anaesthesia in 74 women (18%) found no association between mode of delivery or method of analgesia/anaesthesia and the risk of postpartum relapse or disability progression. 48,74 A 2019 UK consensus statement on pregnancy in MS concluded that MS should not influence the mode of delivery or analgesia/anaesthesia unless there was significant disability. 75 In women with severe spinal cord disease, autonomic dysreflexia should be considered in the differential diagnosis of preeclampsia.…”

Pharmacotherapeutic considerations in women with multiple sclerosis

“…A retrospective cohort study from the Czech Republic included 70 pregnancies to 65 women with MS and compared the impact of delivery mode (vaginal vs cesarean delivery) and type of anesthesia on the course of MS six months postpartum. No difference in postpartum relapses was found when comparing vaginal deliveries with cesarean deliveries in women with MS[115].…”