Care of the Woman with Myasthenia Gravis Throughout Pregnancy and Birth

2.50
Hdl Handle:
http://hdl.handle.net/10755/149729
Type:
Presentation
Title:
Care of the Woman with Myasthenia Gravis Throughout Pregnancy and Birth
Abstract:
Care of the Woman with Myasthenia Gravis Throughout Pregnancy and Birth
Conference Sponsor:Sigma Theta Tau International
Conference Year:2007
Author:Heale, Patricia A., MSN, RNC
P.I. Institution Name:Newton-Wellsley Hospital
Title:Perinatal Clinical Nurse Specialist
[Clinical session research presentation] Myasthenia gravis (MG) is an auto-immune disorder of the neuromuscular junction characterized by varying degrees of weakness within the body's skeletal muscles especially the ocular, bulbar, and limb muscles. MG affects twice as many women as men and is likely to strike women during childbearing years. Worsening of MG symptoms occurs in 30% to 41% of parturients with the most severe symptoms seen when pregnancy occurs within one year of diagnosis. Remission during pregnancy has been seen in 29% of women and no change in condition during pregnancy has been noted in 32% of women. Treatment of MG is complicated by the routine physiologic changes of pregnancy including nausea and vomiting, increased blood volume, changes in renal clearance, and alterations in gastrointestinal motility. Anticholinesterase medications are the first line of treatment for patients with MG but during pregnancy medications may need to be increased due to volume expansion and delayed gastric emptying; other medications include: cyclosporine A, corticosteroids, and azathioprine. The nurse caring for the parturient with MG should take a thorough history including medications, prenatal testing, and laboratory data. A thorough assessment to gauge the patient's stage of MG, potential for infection, and her risk for myasthenic crisis is also needed. The non-stress test can be unreliable as can be kick count records and in labor continuous fetal monitoring is indicated. Ongoing evaluation of the parturient's respiratory status and risk of infection is essential as the stress of labor increases the risk of myasthenic crisis. Cesarean birth poses multiple risks and should only be used for obstetrical indications or myasthenic crisis. A small percentage of newborns may show signs of Neonatal Myasthenia gravis (NMG) between 12 hours to up to three months after delivery. In rare cases respiratory failure may require intubation and mechanical ventilation of the newborn.
Repository Posting Date:
26-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Sigma Theta Tau International

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleCare of the Woman with Myasthenia Gravis Throughout Pregnancy and Birthen_GB
dc.identifier.urihttp://hdl.handle.net/10755/149729-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Care of the Woman with Myasthenia Gravis Throughout Pregnancy and Birth</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Sigma Theta Tau International</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2007</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Heale, Patricia A., MSN, RNC</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Newton-Wellsley Hospital</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Perinatal Clinical Nurse Specialist</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">pheale@partners.org</td></tr><tr><td colspan="2" class="item-abstract">[Clinical session research presentation] Myasthenia gravis (MG) is an auto-immune disorder of the neuromuscular junction characterized by varying degrees of weakness within the body's skeletal muscles especially the ocular, bulbar, and limb muscles. MG affects twice as many women as men and is likely to strike women during childbearing years. Worsening of MG symptoms occurs in 30% to 41% of parturients with the most severe symptoms seen when pregnancy occurs within one year of diagnosis. Remission during pregnancy has been seen in 29% of women and no change in condition during pregnancy has been noted in 32% of women. Treatment of MG is complicated by the routine physiologic changes of pregnancy including nausea and vomiting, increased blood volume, changes in renal clearance, and alterations in gastrointestinal motility. Anticholinesterase medications are the first line of treatment for patients with MG but during pregnancy medications may need to be increased due to volume expansion and delayed gastric emptying; other medications include: cyclosporine A, corticosteroids, and azathioprine. The nurse caring for the parturient with MG should take a thorough history including medications, prenatal testing, and laboratory data. A thorough assessment to gauge the patient's stage of MG, potential for infection, and her risk for myasthenic crisis is also needed. The non-stress test can be unreliable as can be kick count records and in labor continuous fetal monitoring is indicated. Ongoing evaluation of the parturient's respiratory status and risk of infection is essential as the stress of labor increases the risk of myasthenic crisis. Cesarean birth poses multiple risks and should only be used for obstetrical indications or myasthenic crisis. A small percentage of newborns may show signs of Neonatal Myasthenia gravis (NMG) between 12 hours to up to three months after delivery. In rare cases respiratory failure may require intubation and mechanical ventilation of the newborn.</td></tr></table>en_GB
dc.date.available2011-10-26T10:08:19Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-26T10:08:19Z-
dc.description.sponsorshipSigma Theta Tau Internationalen_GB
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