Myasthenia gravis (MG) as well as most other autoimmune diseases affecting approximately twice as many women than men. Therefore, a large proportion of patients with MG meets with gynecologists and obstetricians.
Nowadays, thanks to early diagnosis and early initiation of therapy will achieve more in 90% of young women clinical remission. Times when the diagnosis MG indications for abortion are, fortunately, has long since past. Manifestation of MG during pregnancy is a rare, slightly more frequent in the postpartum period. Virtually all myasthenic may become pregnant and give birth to a healthy baby. We recommend planning pregnancy, at least 2 -3 years after thymektomii by which young women routinely performed. We therefore recommend the use of hormonal contraceptives. The deterioration of MG during pregnancy is relatively rare, but rather comes in the postpartum period, especially during the long lactation, probably at elevated levels of prolactin. The vast majority of women today are born per vias naturales, should try to shorten 2.dobu labor. Indications for caesarean section is exceptional for women, which persists residual weakness of the pelvic muscles. In this case, it is necessary to follow the principles anestheisologické care of patients with MG. Epidural anesthesia is at myasteniček possible.
Approximately 5 to 15% of mothers with myasthenia gravis postpartum period may be a manifestation of transient neonatal myasthenia (TNM), a mechanism of passive transplacental transfer of autoantibodies from the mother's blood into the bloodstream of a child. Clinically manifested poor motor skills, hypotonia, weak cry and suction. Quite rarely undermine the respiratory muscles. With this option should be calculated and the newborn placed on monitored bed. TNM is usually appear 12 to 24 hours after birth, manifestation after 48 hours is rare. Usually subside within 2 weeks. Most therapeutic is administered neostigmine into nasogastric tube.
The most common gynecological problem is the protracted inflammation that can provoke exacerbation of MG. Avoid risky antibiotics. On the contrary, intensive immunosuppressive therapy may gynecological inflammations, often fungal, cause.