Obstetric and perinatal management in myasthenia gravis

Myasthenia gravis is an autoimmune disorder characterized by the presence of IgG antibodies against human acetylcholine receptors on striated muscle. Presentation during pregnancy is very rare. This disease is characterized clinically by fatigability of voluntary muscles, particularly those of the eyes, face, oropharynx and extremities. We report the case of a patient with a term pregnancy and a history of myasthenia gravis. The clinical course during pregnancy, childbirth and the puerperal period, as well as the therapeutic possibilities, are described. Commentary: Myasthenia gravis has an unpredictable course during pregnancy, since this disease can exacerbate or trigger situations of perinatal risk. Treatment with anticholinesterase agents, immunomodulators, plasmapheresis and human immunoglobulin can be used, if necessary, with satisfactory results. The incidence of neonatal myasthenia gravis is unrelated to the severity of the mother's clinical picture and to anticholinesterase antibody titers. (C) 2010 Elsevier Espana, S.L All rights reserved.