Schwere Muskeldystrophie und Schwangerschaft: Interdisziplinäre Herausforderung

Obstetric management of a woman with limb-girdle muscular dystrophy type 2i and dilated cardiomyopathy

Limb-girdle muscular dystrophy describes a clinical phenotype with progressive weakness and atrophy of the muscles of the shoulders and hips. One of the more common types, limb-girdle muscular dystrophy type 2i, is associated with impaired cardiac function and restrictive lung disease, typically disproportionate to muscular disease. This condition presents a number of complex challenges in pregnancy and there are few case reports of its successful management. Here we discuss the course of the first pregnancy of a 20-year-old woman with limb-girdle muscular dystrophy type 2i.

Obstetrical, maternal and neonatal outcomes in pregnancies affected by muscular dystrophy

Objective:

Pregnancies in women affected by a muscular dystrophy are at an increased risk of adverse maternal and neonatal outcomes due to the effect of the disease on the muscular, cardiac and respiratory systems. We sought to evaluate the risk of adverse outcomes within a large population-based cohort study.

Methods:

We used the data extracted from the Nationwide Inpatient Sample (NIS) to conduct a retrospective population-based cohort study consisting of over 12 million births that occurred in the United States between 1999 and 2013. Births to mothers with muscular dystrophy were identified using the International Classification of Diseases, Ninth Revision (ICD-9) codes and were compared with births to mothers with no maternal muscular dystrophy. Unconditional logistic regression analysis was used to evaluate the adjusted effect of muscular dystrophy on maternal and neonatal outcomes.

Results:

During the 14-year study period, there was an increasing trend in the incidence of muscular dystrophy, with a cumulative incidence of 7.26 in 100,000 births. Women with muscular dystrophy and their neonates were at a significantly increased risk of adverse pregnancy outcomes: specifically, an increased risk of preeclampsia, preterm premature rupture of membranes, preterm labor, venous thromboembolism, cardiac dysrhythmia, requiring a blood transfusion and giving birth by cesarean section. Neonates born to affected mothers were at a significantly higher risk of being born preterm, with a congenital malformation and suffering intrauterine growth restriction.

Conclusion:

The risk of several adverse maternal and neonatal outcomes is increased in pregnant women with muscular dystrophy. As such, additional surveillance in order to mitigate the risk of adverse outcomes is warranted in these pregnancies.

Limb-girdle muscular dystrophy with obesity for elective cesarean section: Anesthetic management and brief review of the literature

Limb-girdle muscular dystrophy (LGMD) is an autosomal recessive disorder in which the pelvic or shoulder girdle musculature is predominantly or primarily involved. We report the management of a 27-year-old primigravida with LGMD associated with obesity posted for elective cesarean section. She was successfully managed with epidural anesthesia assisted with noninvasive positive pressure ventilation. She had an uncomplicated intra- and post-operative course.