myaesthenia_gravis-Benjamin

myaesthenia_gravis-Benjamin - Myaesthenia Gravis in...

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Myaesthenia Gravis in Pregnancy. Dr. Mridula A. Benjamin Dept of Obs and Gyn,  RIPAS Hospital, Brunei
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M.J. IC:31-001064 22 yrs. G2P1. Self conception. Non consanguineous. 1 st preg: LMP: ? July 2004. Unbooked case. Emergency LSCS was done in Jan 2005 at 30 wks for severe APH. No significant past medical and family history .
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24/09/05: A&E for sore throat, loss of voice, unable to swallow and sweating. BP: 96/58 mm.Hg. ENT: Diagnosed fx. Aphasia after normal fibroscopy. 25/09: Chest review: Ocular fatigue and facial diaplegia. No obvious motor weakness. Combined resp and metab acidosis. 26/09: Neuro review: Patient dyspnoiec, tachycardic. ANA, Anti-DNA, Tensilon test
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ANA- Mixed homogenous 1:40. Anti-DNA: Negative. Tensilon test: Positive. Repetitive test: +ve. EMG: Muscle weakness. Diagnosed as Myas. Crisis. Treated with pyridostigmine, prednisolone and Azathioprine. Discharged from Neuro on 15/10. Referred by Neuro to O&G on 29/10 for pregnancy after stopping Azathioprine.
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LMP: 29/Aug/05. EDC: 6/6/6 USS: 10 wks pregnant. Advised to continue pyridostigmine and prednisolone.Given folic acid, adv NT Booked into high risk clinic on 22/11. Antenatal screening: NAD. Regular follow ups. Normotensive
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USS at 18 wks: No anomalies. Subsequent USS at 30, 35 and 37 wks showed adequate growth. USS on 16/05: Fetal wt of 3059 gms and AFI of 13. Placenta posterior and upper segment. Paeds counselling on 16/05: Told about resp. insuff. requiring ventilation, feeding difficulties, congenital MG.
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Admitted with tightenings on 29/05/06. Counselled for VBAC. Neuro review was done with adv. of Inj Hydrocortisone 100mg 6 hrly in active labour. On 31/05 : SROM at 1:40 am. Contractions 1: 5: 40, CTG-R. VE: os 1.5, thick cervix, liquor clear, memb absent, stn high. Was given sedation.
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This note was uploaded on 12/24/2011 for the course STEP 1 taught by Professor Dr.aslam during the Fall '11 term at Montgomery College.

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myaesthenia_gravis-Benjamin - Myaesthenia Gravis in...

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