Because smooth muscle is unafected, most women have normal labor. Oxytocin is given for the usual indications, and cesarean delivery is reserved for obstetrical indications. Narcotics may cause respiratory depression, and close observation and respiratory support are essential during labor and delivery. Curariform drugs are avoided-examples include magnesium sulfate discussed above, muscle relaxants used with general anesthesia, and aminoglycosides. Neuraxial analgesia is accomplished with amide-type local agents. Regional analgesia is preferred unless there is signiicant bulbar involvement or respiratory compromise (Almeida, 2010; Blichfeldt-Lauridsen, 2012). During second-stage labor, some women may have impaired voluntary expulsive eforts that may warrant operative vaginal delivery.
As discussed above, 80 percent of mothers with myasthenia gravis have anti-acetylcholine-receptor immunoglobulin G (IgG) antibodies. These and anti-MuSK antibodies cross transplacentally, and the fetus can be afected. Poor fetal swallowing may yield hydramnios (Heaney, 2010). Similarly, 10 to 20 percent of neonates manifest myasthenia symptoms (Jovandaric, 2016). Transient symptoms usually include a feeble cry, poor suckling, and respiratory distress. Symptoms usually respond to cholinesterase inhibitors and resolve within a few weeks as maternal IgG antibodies clear.
Peripheral neuropathy is a general term used to describe disorders of peripheral nerve(s) from various sources. Poyneuropathies can be axonal or demyelinating as well as acute, subacute, or chronic (Amato, 2015). hese are often associated with systemic diseases such as diabetes, with drug or environmental toxin exposure, or with genetic disease.
Mononeuropathies are relatively common in pregnancy and signiY focal involvement of a single nerve trunk. These imply local causation such as trauma, compression, or entrapment. Traumatic pudendal, obturator, femoral, and common fibular mononeuropathies are usually caused by childbirth and are discussed in Chapter 36 (p. 661).
In 75 percent of cases, this acute demyelinating polyradiculoneuropathy has clinical or serological evidence for an acute infection. Commonly associated are infections with Campylobacter jjuni, cytomegalovirus, Zika virus, and Epstein-Barr virus; surgical procedures; and immunizations (Haber, 2009; Hauser, 2015a; Pacheco, 2016). Guillain-Barre syndrome is thought to be immune-mediated from antibodies formed against nonself antigens. Demyelination causes sensory and motor conduction blockade, and remyelination yields recovery in most cases.
Clinical features include areflexic paralysis-usually ascending-with or without sensory disturbances. Autonomic dysfunction is common. The full syndrome develops over 1 to 3 weeks. Some manifest as chronic inlammatoy demyelinating poyneuropathy, and our experiences indicate that this may be relatively common in these young women.