Primigravida with generalized myasthenia gravis leading to caesarean section delivery: a case report

Myasthenia gravis (MG) is a chronic autoimmune disorder affecting the neuromuscular junction, characterized by fluctuating muscle weakness. Pregnancy in women with MG poses unique challenges, as physiological and immunological changes may influence disease activity and obstetric outcomes.

A 25-year-old primigravida with initially ocular myasthenia gravis that progressed to generalized disease during pregnancy presented for delivery at 37 weeks gestation. The patient had initiated regular pyridostigmine therapy at the time of initial diagnosis one year prior to conception and remained free of exacerbations until the current pregnancy. Multidisciplinary coordination between obstetric, neurology, and anesthesia teams was established early. A planned cesarean delivery under spinal anesthesia was performed to minimize maternal respiratory fatigue and avoid myasthenic crisis. Both mother and neonate had favorable outcomes, and no postpartum exacerbation occurred.

Optimal outcomes can be achieved with early diagnosis, monitoring and adequate treatment with a multidisciplinary approach. Delivery decisions based on respiratory assessment and the overall disease stability are crucial in preventing crisis and ensure both neonatal and maternal safety.