Guillain-Barre syndrome is not more common in pregnancy, and its clinical course mirrors that for nonpregnant individuals. After an insidious onset, paresis and paralysis most oten continue to ascend to cause ventilatory weakness. Management is supportive and incorporates venous thromboembolism prophylaxis, pressure ulcer prevention, and enteral nutrition. In the worsening phase, patients are hospitalized, and a fourth requires ventilatory assistance. IVIG or plasmapheresis is beneficial if begun within 1 to 2 weeks of motor symptoms, however, neither decreases mortality rates (Cortese, 2011; Gwathmey, 2011; Pritchard, 2016). Up to 10 percent of patients deteriorate after initial improvement on therapy, and retreatment with 2 g/kg IVIG over 5 days is recommended. Although most patients recover fully within several months to a year, the mortality rate is 5 percent, mainly due to pulmonary complications and arrhythmias (Hauser, 20 15a; Pacheco, 2016).
FIGURE 60-5 Bell facial nerve palsy developing on the day of cesarean delivery for dichorionic twins. This woman was treated with prednisone and antiviral medication, and the palsy had almost resolved 3 weeks postpartum.
his disfiguring palsy is usually a mononeuropathic acute facial paralysis that is relatively common in reproductive-aged women (Fig. 60-5). It has a female predominance, and pregnant women carry a fourfold risk compared with nonpregnant women (Cohen, 2000; Heaney, 2010). The disease is characterized by facial nerve inlammation and often is associated with reactivation of herpes simplex virus or herpes zoster virus.
Bell palsy usually has an abrupt and painful onset with maximum weakness by 48 hours. In some cases, hyperacusis and loss of taste accompany paralysis (Beal, 2015). Management includes supportive care with facial muscle massage and eye protection against corneal lacerations from drying. here is general consensus that prednisone, 1 mg/kg given orally daily for 5 days, will improve outcomes and shorten the recovery period (Salinas, 2016; Sullivan, 2007). It is controversial whether addition of an antiviral medication will add benefits (de Almeida, 2009; Gagyor, 2015; Quant, 2009).
It is unclear if pregnancy alters the prognosis for spontaneous facial palsy recovery. Gillman and associates (2002) found that only half of pregnant women recovered to a satisfactory level after 1 year, compared with approximately 80 percent of nonpregnant women and men. Some prognostic markers for incomplete recovery are bilateral palsy, recurrence in a subsequent pregnancy, greater percentage of nerve function loss, and a faster rate of loss (Cohen, 2000; Gilden, 2004). Other than a ivefold greater rate for gestational hypertension or preeclampsia, women with Bell palsy do not have increased adverse pregnancy outcomes rates (Katz, 2011; Shmorgun, 2002).