Anesthetic considerations for myasthenia gravis and pregnancy

Three pregnant patients with myasthenia gravis are presented and anesthetic considerations discussed. The course of myasthenia gravis is highly variable and unpredictable during pregnancy. Anticholinesterase therapy should be maintained during labor, and the IM route of administration is preferred. Exacerbations very often occur in the immediate postpartum period. Regional anesthesia is preferred for vaginal delivery. In the case of cesarean section, general anesthesia may be preferable. Neonatal myasthenia gravis is a transient syndrome that appears in 20 to 30% of the newborns of myasthenic mothers.