Challenges of a Pregnant Woman With Untreated Myasthenia Gravis: Delivery and Puerperium

Myasthenia gravis (MG) is a rare autoimmune neurological disorder. Pregnancy, labor, and puerperium are risk factors for a myasthenic crisis. This case reports a late 20s pregnant woman evacuated from Guinea-Bissau with the diagnosis of generalized and severe MG, tetraparetic, at 38 weeks of gestation. She had never been treated for MG. After multidisciplinary assessment and despite current recommendations, intensive therapy with IV immunoglobulin and pyridostigmine was started and labor was induced. There were no neonatal complications. There was a worsening of symptoms during puerperium and therapy intensification with additional corticosteroids being needed. Labor in women with non-treated MG carries a high risk for serious and even fatal complications both for mother and child. Despite being a rare condition, it is more frequent in women of childbearing age, and guidelines on this topic are scarce.