[Myasthenia and pregnancy. Apropos of 8 cases]

In 10 years we dealt with 8 cases of pregnancy in myasthenic women. Pregnancy does not seem to cause myasthenia to develop. Worsening of the condition, which we found in 40% of our cases, occurs particularly in the first trimester and nearly always regresses. Another critical period is after delivery. Deaths are not unusual in the literature but we did not have to record one in our study. Because myasthenia evolves in different ways it is important to watch these cases carefully and as soon as the diagnosis has been made stabilising treatment is needed. The patient has to be watched for at least two months after the delivery. During the pregnancy the first line of treatment is to use anticholinesterases which do not have any teratogenic effects. In our study all the women carried their pregnancies to term; although in the literature 10-40% of deliveries were premature. This fact makes one consider whether there is an oxytocic effect of anti-cholinesterases. If the mother becomes very tired she should have very little expulsive effort to carry out. Forceps delivery, which is often necessary, is helped if an epidural anaesthetic is given. Breast feeding by the mother can only be carried out if the myasthenia is stable and if there are weak levels of anti-receptor antibodies to acetylcholine. 50% of the newborn are often small for dates and show transitory myasthenia after delivery. The literature, however, shows only 10-20%. This finding is not always correlated with the levels of anti-receptor antibodies for acetylcholine. If they are present, they are useful to diagnose transitory myasthenia.(ABSTRACT TRUNCATED AT 250 WORDS)