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Research paper
Myasthenia in pregnancy: best practice guidelines from a UK multispecialty working group
  1. Fiona Norwood1,
  2. Mandish Dhanjal2,
  3. Marguerite Hill3,
  4. Natalie James4,
  5. Heinz Jungbluth5,
  6. Pippa Kyle6,
  7. Geraldine O'Sullivan7,
  8. Jacqueline Palace8,
  9. Stephanie Robb9,
  10. Catherine Williamson10,
  11. David Hilton-Jones8,
  12. Catherine Nelson-Piercy11
  1. 1Department of Neurology, Ruskin Wing, King's College Hospital, Denmark Hill, London, UK.
  2. 2Department of Obstetrics, Queen Charlotte's and Chelsea Hospital, London, UK
  3. 3Department of Neurology, Morriston Hospital, Swansea, UK
  4. 4MRC Centre for Neuromuscular Diseases, National Hospital for Neurology & Neurosurgery, London, UK
  5. 5Department of Paediatric Neurology, Guy's and St Thomas’ Hospital, London, UK
  6. 6Department of Fetal Medicine, Guy's and St Thomas’ Hospital, London, UK
  7. 7Department of Obstetric Anaesthesia, Guy's and St Thomas’ Hospital, London, UK
  8. 8Department of Neurology, John Radcliffe Hospital, Oxford, UK
  9. 9Dubowitz Neuromuscular Centre, Great Ormond Street Hospital and Institute of Child Health, London, UK
  10. 10Department of Obstetrics, Imperial College, London, UK
  11. 11Department of Obstetric Medicine, Guy's and St Thomas’ Hospital, London, UK
  1. Correspondence to Dr Fiona Norwood, Department of Neurology, King's College Hospital, 9th Floor, Ruskin Wing, Denmark Hill, London SE5 9RS, UK; Fiona.Norwood{at}nhs.net

Abstract

A national UK workshop to discuss practical clinical management issues related to pregnancy in women with myasthenia gravis was held in May 2011. The purpose was to develop recommendations to guide general neurologists and obstetricians and facilitate best practice before, during and after pregnancy. The main conclusions were (1) planning should be instituted well in advance of any potential pregnancy to allow time for myasthenic status and drug optimisation; (2) multidisciplinary liaison through the involvement of relevant specialists should occur throughout pregnancy, during delivery and in the neonatal period; (3) provided that their myasthenia is under good control before pregnancy, the majority of women can be reassured that it will remain stable throughout pregnancy and the postpartum months; (4) spontaneous vaginal delivery should be the aim and actively encouraged; (5) those with severe myasthenic weakness need careful, multidisciplinary management with prompt access to specialist advice and facilities; (6) newborn babies born to myasthenic mothers are at risk of transient myasthenic weakness, even if the mother's myasthenia is well-controlled, and should have rapid access to neonatal high-dependency support.

  • Myasthenia

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