Publications

Introduction: Myasthenia gravis (MG) is an acquired neuromuscular disorder that presents with clinical weakness and fatigue of the skeletal muscles. Pregnancy can have significant effects on the course of myasthenia gravis. Patients with well-controlled MG prior to conception usually have a benign disease course during pregnancy, although a small number may deteriorate during the postpartum period. Case description: A 22-year-old primigravida was referred to our hospital for further antenatal management, as she was a known case of MG. Myasthenia gravis was diagnosed at the age of 17, when she developed drooping of eyelids, and weakness of both upper and lower limbs. Acetylcholine receptor antibodies were positive. Her symptoms improved with oral prednisolone and pyridostigmine, but caused bilateral avascular necrosis of the hip requiring core decompression surgery. She further required thymectomy a year later. The patient's myasthenic symptoms were well-controlled prior to conception and she remained asymptomatic throughout pregnancy while continuing pyridostigmine. She underwent an elective cesarean section at 39 weeks of pregnancy due to her prior history of avascular necrosis of bilateral hip and her postpartum period was uneventful. Conclusion: Pregnancies associated with MG can have a stable disease course if adequately stabilized with drugs or thymectomy prior to pregnancy. Antenatal management by a multidisciplinary approach, along with appropriate immunosuppressants can improve both maternal and neonatal outcomes.