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Hui L, Hayman P, Buckland A, Fahey MC, Mackey DA, Mallett AJ, Schweitzer DR, Stuart CP, Yau WY, Christodoulou J. Pregnancy in women with mitochondrial disease-A literature review and suggested guidance for preconception and pregnancy care. Aust N Z J Obstet Gynaecol 2024. [PMID: 39258766 DOI: 10.1111/ajo.13874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Accepted: 08/11/2024] [Indexed: 09/12/2024]
Abstract
Mitochondrial donation to reduce the risk of primary mitochondrial disease transmission from mother to child is now permitted under Australian law as part of a clinical trial. The energy demands of pregnancy have the potential to worsen mitochondrial disease symptoms and severity in affected women. We conducted a systematic literature review on mitochondrial disease in pregnancy; five cohort studies and 19 case reports were included. For many women with mitochondrial disease, pregnancy does not have a negative effect on health status. However, serious adverse outcomes may occur. We provide suggested guidelines for preconception counselling and antenatal care.
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Affiliation(s)
- Lisa Hui
- Department of Obstetrics, Gynaecology and Newborn Health, University of Melbourne, Melbourne, Victoria, Australia
- Reproductive Epidemiology Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Perinatal Medicine, Mercy Hospital for Women, Melbourne, Victoria, Australia
- Department of Obstetrics and Gynaecology, The Northern Hospital, Melbourne, Victoria, Australia
| | - Pema Hayman
- College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
| | - Ali Buckland
- Department of Neurology, Perron Institute for Neurological and Translational Science, Perth, Western Australia, Australia
| | - Michael C Fahey
- Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
| | - David A Mackey
- Centre for Ophthalmology and Visual Science, Lions Eye Institute, University of Western Australia, Perth, Western Australia, Australia
| | - Andrew J Mallett
- College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
- Department of Renal Medicine, Townsville University Hospital, Townsville, Queensland, Australia
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, Queensland, Australia
| | - Daniel R Schweitzer
- Department of Neurology, Mater Hospital, Brisbane, Queensland, Australia
- Wesley Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | | | - Wai Yan Yau
- Department of Neurology, Perron Institute for Neurological and Translational Science, Perth, Western Australia, Australia
| | - John Christodoulou
- Brain and Mitochondrial Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
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Balachandran Nair D, Bloomfield M, Parasuraman R, Howe DT. Mitochondrial encephalomyopathy, lactic acidosis and stroke-like episodes (MELAS) syndrome in pregnancy. BMJ Case Rep 2021; 14:14/4/e235111. [PMID: 33827862 PMCID: PMC8030665 DOI: 10.1136/bcr-2020-235111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The syndrome of mitochondrial encephalomyopathy, lactic acidosis and stroke-like episodes (MELAS) is a rare mitochondrial disease with few documented cases in pregnancy. In this case report, we discuss the presentation and management of a 39-year-old grand multiparous lady with MELAS syndrome, which was diagnosed prior to her eighth pregnancy, discuss potential implications of the condition in pregnancy and summarise the current guidelines for the management of this rare condition.
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Affiliation(s)
- Deepa Balachandran Nair
- Department of Obstetrics and Gynaecology, Stoke Mandeville Hospital, Aylesbury, UK .,Department of Obstetrics and Gynaecology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Mariana Bloomfield
- Department of Obstetrics and Gynaecology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Rajeswari Parasuraman
- Wessex Fetal Medicine Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - David T Howe
- Wessex Fetal Medicine Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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Neurology. Image-based Clinical Review. J Neurosurg Anesthesiol 2018. [DOI: 10.1097/ana.0000000000000379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bell JD, Higgie K, Joshi M, Rucker J, Farzi S, Siddiqui N. Anesthetic Management of Mitochondrial Encephalopathy With Lactic Acidosis and Stroke-Like Episodes (MELAS Syndrome) in a High-Risk Pregnancy: A Case Report. ACTA ACUST UNITED AC 2017; 9:38-41. [PMID: 28398928 DOI: 10.1213/xaa.0000000000000520] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
MELAS syndrome (mitochondrial encephalopathy, lactic acidosis, and stroke-like symptoms) is a rare and complex mitochondrial disorder. We present the in-hospital course of a 36-year-old gravida 2, para 0 with MELAS syndrome and severe preeclampsia, complicated by hyponatremia, hyperkalemia, and diabetes. A retained placenta with postpartum hemorrhage required urgent instrumental delivery under spinal anesthesia, transfusion, and intensive care unit admission for pulmonary edema, effusions, and atelectasis. Postpartum endometritis and sepsis also were encountered. This is to our knowledge the first case report of obstetric complications in MELAS syndrome and highlights the salient metabolic sequelae of this syndrome.
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Affiliation(s)
- Josh D Bell
- From the *Department of Anesthesiology, University of Toronto; and †Department of Anesthesia and Pain Management, Mount Sinai Hospital, Toronto, Ontario, Canada
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Fedriani JJ. [Anesthetic management of a patient with mitochondrial encephalomyopathy underwent emergency open cholecystectomy]. ACTA ACUST UNITED AC 2013; 61:471-2. [PMID: 24287083 DOI: 10.1016/j.redar.2013.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Revised: 09/25/2013] [Accepted: 09/30/2013] [Indexed: 10/26/2022]
Affiliation(s)
- J J Fedriani
- Servicio de Anestesiología y Reanimación, Hospital de Jerez de la Frontera, Jerez de la Frontera, Cádiz, España.
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Gurrieri C, Kivela JE, Bojanić K, Gavrilova RH, Flick RP, Sprung J, Weingarten TN. Anesthetic considerations in mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes syndrome: a case series. Can J Anaesth 2011; 58:751-63. [PMID: 21656321 DOI: 10.1007/s12630-011-9528-0] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2011] [Accepted: 05/12/2011] [Indexed: 01/12/2023] Open
Abstract
PURPOSE Mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes syndrome (MELAS) is a rare inherited mitochondrial disorder associated with severe multiorgan pathology and stress-induced episodes of metabolic decompensation and lactic acidosis. The purpose of this case series is to review the medical records of patients with MELAS who underwent anesthetic care at the Mayo Clinic to observe their perioperative responses to anesthesia and to assess outcomes. PRINCIPAL FINDINGS From September 1997 to October 2010, nine patients with MELAS were identified who underwent 20 general anesthetics, 12 prior to MELAS diagnosis. Debilitating neurologic symptoms involved eight patients, and three patients had substantial cardiac comorbidities. The patients tolerated commonly used anesthetics and muscle relaxants, including succinylcholine. Lactated Ringer's solution was used frequently. One patient was noted to have elevated postoperative serum lactate, but his serum lactate was chronically elevated. Metabolic acidosis was not observed in any patient. Hyponatremia and hyperkalemia, sometimes profound, were observed in seven patients, but these abnormalities also occurred at times remote from surgery. Two patients developed renal dysfunction following cardiac surgery and abdominal surgery for severe sepsis. CONCLUSION The MELAS patients developed episodes of hyponatremia and hyperkalemia of variable severity unrelated to the timing of surgery, suggesting these patients are prone to major electrolyte disturbances. Given the propensity to develop acid-base disturbances and lactacidemia, it is prudent to review and normalize electrolyte abnormalities and to adjust the anesthetic plan accordingly. Fortunately, the limited data suggest that patients with MELAS tolerate commonly used anesthetic drugs well.
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Affiliation(s)
- Carmelina Gurrieri
- Department of Anesthesiology, College of Medicine, Mayo Clinic, Rochester, MN 55905, USA
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