Objectif. - Etudier les interferences reciproques entre grossesse et myasthenie et decrire la prise en charge anesthesique et obstetricale pendant le travail et le post-partum.Type de l'etude. - Enquete retrospective.Methodologie. - Etude des dossiers des dix patientes myastheniques suivies entre octobre 1994 et mai 2002.Resultats. - Aucune fausse-couche n'est survenue et toutes les grossesses ont ete menees a terme. Toutes les patientes suivaient un traitement de fond par anticholinesterasiques qui a ete maintenu. Sept poussees ont ete depistees chez six patientes et enrayees par une majoration des traitements (n = 5), par plasmapherese (n = 1) ou par immunoglobulines (n = 1). Toutes les patientes ont eu une consultation pre-anesthesique autour de la 33 e SA. Une analgesie locoregionale precocement installee utilisant des concentrations faibles d'anesthesique local (peridurale, n = 7 ; rachianalgesie-peridurale, n = 2) s'est deroulee sans incident ni bloc moteur notable. Trois patientes ont beneficie d'une cesarienne pour indication obstetricale. Sept ont accouche par voie basse avec extraction instrumentale (n = 5). En post-partum, quatre patientes ont ete surveillees en reanimation pendant 48 heures. Un suivi neurologique n'a montre aucune decompensation grave pendant les six premieres semaines post-partum.Conclusion. - L'aggravation de la myasthenie survient surtout a un terme precoce et peut etre controlee par un suivi etroit qui permet egalement un deroulement de la grossesse sans modification notable. L'accouchement par voie basse avec extraction instrumentale est generalement possible. L'analgesie locoregionale est une indication medicale et doit etre precocement mise en place en evitant le bloc moteur grace a l'emploi de concentrations faibles.
Objective. - To study the reciprocal interferences between pregnancy and myasthenia gravis (MG) and to describe obstetric and anaesthetic management during labour and the post-partum period.Study design. - Retrospective, single centre study.Methods. - The files of 10 patients with MG, who delivered between October 1994 and May 2002, were examined.Results. - No stillbirth occurred and all pregnancies were brought to term. All patients were maintained on their long-term anticholinesterase medications during pregnancy. Seven exacerbations were detected and controlled, five by increasing the anticholinesterase treatment, one by using plasmapheresis and one by using intravenous immunoglobulins. No patient required admission to the intensive care unit during pregnancy. All patients had a pre-anaesthetic visit at/near 33 weeks of gestation. Delivery was induced for six patients. Regional analgesia was performed early in labour (epidural, n = 7; combined spinal-epidural = 2) using low concentrations of local anaesthetic and no complication was detected. Three patients required a caesarean section for an obstetrical indication. Seven patients delivered vaginally using instrumental extraction (n = 5). During the post-partum period, four patients were monitored in the intensive care unit during 48 h and close neurological follow-up disclosed no exacerbation during the first 6 post-partum weeks.Conclusions. - MG has no significant effect on the course of pregnancy and delivery, but MG exacerbation can occur, especially in the first trimester. Regional analgesia is medically indicated and must be performed early in labour, using low concentration of local anaesthetic to lessen the risk of motor block.