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Racca F, Longhitano Y, Zanza C, Draisci G, Stoia PA, Gollo E, Maio M, Grattarola C, Astuto M, Vaschetto R, Sansone VAM, Conti G, Gregoretti C. Peri-Partum respiratory management in neuro-muscular disorders (IT-NEUMA-Pregn study): A proposal by an italian panel and a call for an international collaboration. Pulmonology 2024; 30:210-213. [PMID: 36907810 DOI: 10.1016/j.pulmoe.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 01/18/2023] [Accepted: 02/13/2023] [Indexed: 03/12/2023] Open
Affiliation(s)
- F Racca
- Department of Anesthesiology and Intensive Care, Azienda Ospedaliera SS, Antonio e Biagio e Cesare Arrigo, Via Venezia, 16, 15121 Alessandria, Italy, EU
| | - Y Longhitano
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - C Zanza
- Department of Integrated Research and Innovation Activities, Service of Translational Medicine, AON SS. Antonio e Biagio e Cesare Arrigo H, Alessandria, Italy.
| | - G Draisci
- Institute of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - P A Stoia
- Anesthesiology and Intensive Care Unit, ASST Grande Ospedale Metropolitano Niguarda Ca'Granda, Milan, Italy
| | - E Gollo
- Department of Anesthesiology, Intensive Care A.O.U, Città della Salute e della Scienza di Torino C.so Bramante 88/90, 10126 Torino, Italy
| | - M Maio
- Department of Anesthesiology, Intensive Care A.O.U, Città della Salute e della Scienza di Torino C.so Bramante 88/90, 10126 Torino, Italy
| | - C Grattarola
- Anesthesiology and Intensive Care Unit, Istituto Giannina Gaslini, Genova, Italy
| | - M Astuto
- Dipartimento Chirurgia Generale e Specialità Medico Chirurgiche, A.O.Universitaria "Policlinico-Vittorio Emanuele", Università degli Studi di Catania, Italy
| | - R Vaschetto
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - V A M Sansone
- The NEMO Clinical Center in Milan, Neurorehabilitation Unit, University of Milan, ERN for Neuromuscular Diseases, Milano, Italy
| | - G Conti
- Institute of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - C Gregoretti
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo, Italy; Fondazione Istituto "G. Giglio" Cefalù, Palermo, Italy
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Racca F, Longhitano Y, Zanza C, Balzanelli MG, Draisci G, Stoia PA, Gollo E, Maio M, Grattarola C, Astuto M, Ciccarelli A, Racca G, Romenskaya T, Giordano B, Serraino A, Sansone VAM, Gregoretti C, Conti G, Piccolella F, Vaschetto R. Peri-partum respiratory management of pregnant women with neuro-muscular disorders: a prospective observational study (IT-NEUMA-Pregn study). BMC Anesthesiol 2023; 23:342. [PMID: 37833635 PMCID: PMC10571352 DOI: 10.1186/s12871-023-02307-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 10/09/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Pregnant women with neuromuscular diseases (NMDs) often display respiratory muscle impairment which increases the risk for pulmonary complications (PCs). The aim of this study was to identify pregnant NMDs patients with pulmonary risk factors and to apply in these women non-invasive ventilation (NIV) combined with mechanical insufflation-exsufflation (MI-E) in the peri-partum period. METHODS We conducted a multicenter observational study on women with NMDs undergoing cesarean section or spontaneous labor in a network of 7 national hospitals. In these subjects we applied a protocol for screening and preventing PCs, and we evaluated PCs rate, maternal and neonatal outcome. RESULTS Twenty-four patients out of the 94 enrolled pregnant women were at risk for PCs and were trained or retrained to use NIV and/or MI-E before delivery. After delivery, 17 patients required NIV with or without MI-E. Despite nine out of the 24 women at pulmonary risk developed postpartum PCs, none of them needed reintubation nor tracheostomy. In addition, the average birth weight and Apgar score were normal. Only one patient without pulmonary risk factors developed postpartum PCs. CONCLUSION This study showed the feasibility of applying a protocol for screening and treating pregnant NMDs women with pulmonary risk. Despite a PCs rate of 37% was observed in these patients, maternal and neonatal outcome were favorable.
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Affiliation(s)
- Fabrizio Racca
- Department of Anesthesiology and Intensive Care, Azienda Ospedaliera SS. Antonio E Biagio E Cesare Arrigo, Alessandria, Italy
- Division of Anesthesia and Critical Care Medicine, Azienda Ospedaliera Ordine Mauriziano, Turin, Italy
| | - Yaroslava Longhitano
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Christian Zanza
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
- Post Graduate School of Geriatric Medicine, University of Rome "Tor Vergata", Rome, Italy.
| | | | - Gaetano Draisci
- Institute of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Paolo Augusto Stoia
- Anesthesiology and Intensive Care Unit, ASST Grande Ospedale Metropolitano Niguarda Ca'Granda, Milan, Italy
| | - Evelina Gollo
- Department of Anesthesiology and Intensive Care A.O.U. Città Della Salute E Della Scienza Di Torino, Turin, Italy
| | - Mariella Maio
- Department of Anesthesiology and Intensive Care A.O.U. Città Della Salute E Della Scienza Di Torino, Turin, Italy
| | - Claudia Grattarola
- Anesthesiology and Intensive Care Unit, Istituto Giannina Gaslini, Genova, Italy
| | - Marinella Astuto
- Dipartimento Chirurgia Generale e Specialità Medico Chirurgiche, A.O.Universitaria "Policlinico-Vittorio Emanuele", Università Degli Studi Di Catania, Catania, Italy
| | - Antonello Ciccarelli
- Department of Movement, Human, and Health Sciences - Division of Health Sciences, University of Rome "Foro Italico, Rome, Italy
| | - Giulia Racca
- Division of Anesthesia and Critical Care Medicine, Azienda Ospedaliera Ordine Mauriziano, Turin, Italy
| | - Tatsiana Romenskaya
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Benedetta Giordano
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | | | - Valeria Ada Maria Sansone
- The NEMO Clinical Center in Milan, Neurorehabilitation Unit, University of Milan- ERN for Neuromuscular Diseases, Milan, Italy
| | - Cesare Gregoretti
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo, Palermo, Italy
- Fondazione Istituto "G. Giglio" Cefalù, Palermo, Italy
| | - Giorgio Conti
- Institute of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Fabio Piccolella
- Department of Anesthesiology and Intensive Care, Azienda Ospedaliera SS. Antonio E Biagio E Cesare Arrigo, Alessandria, Italy
| | - Rosanna Vaschetto
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
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Setyaningrum CTS, Harahap ISK, Nurputra DK, Rachman IT, Harahap NIF. Managing pregnancy in a spinal muscular atrophy type III patient in Indonesia: a case report. J Med Case Rep 2022; 16:14. [PMID: 35033190 PMCID: PMC8761282 DOI: 10.1186/s13256-021-03226-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 12/09/2021] [Indexed: 11/10/2022] Open
Abstract
Background Spinal muscular atrophy is a genetic disorder characterized by degeneration of lower motor neurons, leading to progressive muscular atrophy and even paralysis. Spinal muscular atrophy usually associated with a defect of the survival motor neuron 1 (SMN-1) gene. Classification of spinal muscular atrophy is based on the age of onset and maximum motor function milestone achieved. Although spinal muscular atrophy can be screened for in newborns, and even confirmed earlier genetically, this remains difficult in Third World countries such as Indonesia. Case presentation A 28-year-old Asian woman in the first trimester of her second pregnancy, was referred to the neurology department from the obstetric department. Her milestone history showed she was developmentally delayed and the ability to walk independently was reached at 26 months old. At 8 years old, she started to stumble and lose balance while walking. At this age, spinal muscular atrophy was suspected because of her clinical presentations, without any molecular genetic testing. She was married at the age of 25 years and was soon pregnant with her first child. At the gestational age of 32 weeks, her first pregnancy was ended by an emergency caesarean section because of premature rupture of the membranes. In this second pregnancy, she was referred early to the general hospital from the district hospital to receive multidisciplinary care. She and her first daughter underwent genetic testing for spinal muscular atrophy, which has been readily available in our institution since 2018, to confirm the diagnosis and prepare for genetic counseling. Conclusions Managing pregnancy in a patient with spinal muscular atrophy should be performed collaboratively. In this case, genetic testing of spinal muscular atrophy and the collaborative management of this patient allowed the clinical decision making and genetic counseling throughout her pregnancy and delivery.
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Affiliation(s)
| | - Indra Sari Kusuma Harahap
- Department of Neurology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Dian Kesumapramudya Nurputra
- Department of Pediatrics, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Irwan Taufiqur Rachman
- Department of Obstetric and Gynecology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Nur Imma Fatimah Harahap
- Department of Clinical Pathology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
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Evkaya Acar A, Karadağ Saygı E, İmamoğlu S, Öztürk G, Ünver O, Ergenekon P, Gökdemir Y, Özel G, Türkdoğan D. The Burden of Primary Caregivers of Spinal Muscular Atrophy Patients and Their Needs. Turk Arch Pediatr 2022; 56:366-373. [PMID: 35005732 PMCID: PMC8655964 DOI: 10.5152/turkarchpediatr.2021.20117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 11/06/2020] [Indexed: 12/14/2022]
Abstract
Aim: This study aims to reveal the problems faced by families of children with spinal muscular atrophy (SMA), by evaluating their care burden, needs, and expectations. Materials and Methods: The participants were the primary caregivers of 34 children between the ages of 0 and 18 years diagnosed with SMA. Thirteen children were diagnosed with type 1, 13 children with type 2 and 8 children with type 3 SMA. Data on the medical history, functional levels of the participants, and the characteristics of families were collected. The childrens’ parents completed the Family Needs Survey and the Zarit Caregiver Burden Scale. Results: According to the results of the Family Needs Survey, it was found that information was the most common requirement, and this was independent of the level of education. According to the Caregiver Burden Scale, it was recorded that 64.7% of the caregivers were under mild/moderate burden. While there was a moderate correlation (r = 0.574; P < .001) between the Caregiver Burden Scale and the Family Needs Survey, it was observed that the functional level of the child was not associated with family needs and caregiver burden. Conclusions: Our study suggests that the needs of families of SMA patients, especially related to income level, have changed. The caregivers’ burden is not directly related to the income level or the functional level of the child. Families’ need for information should also be prioritized within the rehabilitation program.
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Affiliation(s)
- Ayça Evkaya Acar
- Department of Physical Therapy and Rehabilitation, Istanbul Medeniyet University School of Health Sciences, Istanbul, Turkey
| | - Evrim Karadağ Saygı
- Department of Physical Medicine and Rehabilitation, Marmara University School of Medicine, Istanbul, Turkey
| | - Sena İmamoğlu
- Department of Physical Medicine and Rehabilitation, Marmara University School of Medicine, Istanbul, Turkey
| | - Gülten Öztürk
- Department of Pediatric Neurology, Marmara University School of Medicine, Istanbul, Turkey
| | - Olcay Ünver
- Department of Pediatric Neurology, Marmara University School of Medicine, Istanbul, Turkey
| | - Pınar Ergenekon
- Department of Pediatric Pulmonology, Marmara University School of Medicine, Istanbul, Turkey
| | - Yasemin Gökdemir
- Department of Pediatric Pulmonology, Marmara University School of Medicine, Istanbul, Turkey
| | - Gülnur Özel
- Department of Pediatric Neurology, Marmara University School of Medicine, Istanbul, Turkey
| | - Dilşad Türkdoğan
- Department of Pediatric Neurology, Marmara University School of Medicine, Istanbul, Turkey
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Unexpected but successful non-instrumental vaginal delivery in a spinal muscular atrophy type II pregnant patient. Neurol Sci 2021; 42:3901-3902. [PMID: 34089110 DOI: 10.1007/s10072-021-05344-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 05/21/2021] [Indexed: 10/21/2022]
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Abati E, Corti S. Pregnancy outcomes in women with spinal muscular atrophy: A review. J Neurol Sci 2018; 388:50-60. [DOI: 10.1016/j.jns.2018.03.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 02/03/2018] [Accepted: 03/01/2018] [Indexed: 12/11/2022]
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Elsheikh BH, Zhang X, Swoboda KJ, Chelnick S, Reyna SP, Kolb SJ, Kissel JT. Pregnancy and delivery in women with spinal muscular atrophy. Int J Neurosci 2017; 127:953-957. [PMID: 28102719 DOI: 10.1080/00207454.2017.1281273] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To expand the limited available knowledge about pregnancy and delivery in women with spinal muscular atrophy (SMA) using a cohort of genetically proven SMA patients from USA. METHODS This was a cross-sectional questionnaire-based study. We mailed questionnaires to 58 women with confirmed SMA. RESULTS Thirty-two women responded, reporting 35 pregnancies, including 19 women with at least one pregnancy. In this cohort, preterm labor and delivery by cesarean section were more common in mothers with SMA particularly SMA type 2. Seventy-four percent of mothers reported increased weakness during pregnancy that persisted after delivery in 42%. SMA mothers generally had a positive experience and good outcomes and elected to have more than one pregnancy. CONCLUSION This information regarding pregnancy in women with genetically confirmed 5q SMA will prove useful in guiding future research and in providing counseling to women with SMA.
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Affiliation(s)
- Bakri H Elsheikh
- a Neurology , Johns Hopkins Aramco Healthcare , Dhahran , Saudi Arabia
| | - Xiaoli Zhang
- b Center for Biostatistics , The Ohio State University Wexner Medical Center , Columbus , OH , USA
| | - Kathryn J Swoboda
- c Department of Neurology , Massachusetts General Hospital , Boston , MA , USA
| | - Sharon Chelnick
- d Department of Neurology , The Ohio State University Wexner Medical Center, Columbus , OH , USA
| | - Sandra P Reyna
- e Neurology Clinical Research Institute , Massachusetts General Hospital , Boston , MA , USA
| | - Stephen J Kolb
- d Department of Neurology , The Ohio State University Wexner Medical Center, Columbus , OH , USA
| | - John T Kissel
- d Department of Neurology , The Ohio State University Wexner Medical Center, Columbus , OH , USA
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Total intravenous anesthesia for cesarean section in a pregnant woman with spinal muscular atrophy. Chin Med J (Engl) 2014. [DOI: 10.1097/00029330-201409200-00028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Schwangerschaftsverlauf und geburtshilfliche Risiken bei 178 Frauen mit hereditären neuromuskulären Erkrankungen. MED GENET-BERLIN 2013. [DOI: 10.1007/s11825-013-0410-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Zusammenfassung
Hintergrund
Informationen zu Schwangerschaft und Entbindung bei Frauen mit hereditären neuromuskulären Erkrankungen (NMD) sind aufgrund der Seltenheit meist auf kleine Fallserien und Kasuistiken beschränkt.
Ziel der Arbeit
Die Frage, ob erhöhte geburtshilfliche Risiken und eine mögliche Beeinflussung des Krankheitsverlaufes bestehen, ist auch für die genetische Beratung von großer Bedeutung und soll in der vorliegenden Studie untersucht werden.
Methode
Die Schwangerschaftsverläufe von Frauen mit myotoner Dystrophie Typ 1 (DM1) und Typ 2 (DM2), Charcot-Marie-Tooth-Neuropathie (CMT), proximaler spinaler Muskelatrophie (SMA), Gliedergürtelmuskeldystrophie (LGMD), fazioskapulohumeraler Muskeldystrophie (FSHD) und kongenitaler Myopathie (CM) wurden retrospektiv untersucht. Es wurden 380 Schwangerschaften mit 315 Neugeborenen von 178 Patientinnen dokumentiert.
Ergebnisse und Schlussfolgerung
Die Fehlgeburtenrate war im Normbereich. Frühgeburten, vaginale Operation und Kaiserschnitte stellten v. a. bei DM1 und SMA wichtige Komplikationen dar, während fetale Lageanomalien gehäuft bei DM1, LGMD und rollstuhlpflichtigen Patientinnen auftraten. Abgesehen von DM1-Geburten mit kongenitaler Form war der Gesundheitszustand der Neugeborenen gut. Eine erhebliche Verschlechterung während der Schwangerschaft gaben insbesondere Frauen mit LGMD an.
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Cuisset JM, Estournet B. Recommendations for the diagnosis and management of typical childhood spinal muscular atrophy. Rev Neurol (Paris) 2012; 168:902-9. [PMID: 23107878 DOI: 10.1016/j.neurol.2012.07.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2011] [Revised: 07/26/2012] [Accepted: 07/27/2012] [Indexed: 10/27/2022]
Abstract
Typical childhood spinal muscular atrophy is a disease that affects the anterior horn of the spinal cord related to SMN1 gene defects. Since no etiological treatment is currently available, its management is necessarily symptomatic and involves multidisciplinary care. The national plan on rare diseases for 2005-2008 developed by the French Ministry of Health resulted in the creation of 12 reference centres for neuromuscular diseases, mainly to improve their diagnosis and management. During the first one-day clinical research meeting on neuromuscular disorders, organized by the French Association to fight myopathies (AFM) in May 2007, clinicians from the 12 national reference centers led workshops for each of the main neuromuscular diseases. Concerning spinal muscular atrophy, discussions involving specialists from medical and allied professions were led by clinicians in charge of the workshop sessions. This paper reports the final version of their recommendation regarding the diagnosis, monitoring and management of typical infantile spinal muscular atrophy, which is necessarily multidisciplinary, including orthopedic, pulmonary, gastroenterology and nutrition care.
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Affiliation(s)
- J-M Cuisset
- Department of Neuropediatrics, Neuromuscular Disease Reference Centre, Roger-Salengro Hospital, Regional University Teaching Hospital (CHRU), rue Emile-Lainé, Lille, France.
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Awater C, Zerres K, Rudnik-Schöneborn S. Pregnancy course and outcome in women with hereditary neuromuscular disorders: comparison of obstetric risks in 178 patients. Eur J Obstet Gynecol Reprod Biol 2012; 162:153-9. [PMID: 22459654 DOI: 10.1016/j.ejogrb.2012.02.020] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2011] [Revised: 01/27/2012] [Accepted: 02/20/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Information about pregnancy and delivery in hereditary neuromuscular disorders (NMD) is limited and largely restricted to small case series and single case reports. Further data of obstetric histories in clinically and genetically defined subgroups are required. STUDY DESIGN We reviewed the obstetric histories of 178 patients with myotonic dystrophy type 1 (DM1) and 2 (DM2), Charcot-Marie-Tooth disease (CMT), spinal muscular atrophy (SMA), limb-girdle muscular dystrophy (LGMD), facioscapulohumeral muscular dystrophy (FSHD), and congenital myopathy (CM) by means of questionnaires and medical reports. Patients were recruited in the period 1992-2010 after they had at least completed one pregnancy. A total of 380 pregnancies resulting in 315 children were documented. RESULTS Compared to the normal German population, the number of miscarriages and hypertensive diseases in pregnancy was not increased in the cohort. Patients with NMD delivered more frequently by vaginal operations (8.9-18.2%) and by cesarean births with significantly high rates in DM1 (36.7%) and SMA (42.4%). Preterm deliveries were recorded in 30.7% of DM1, 12.6% of DM2, and 29.4% of SMA gestations. Abnormal fetal presentation occurred significantly more frequently in DM1 (34.6%) and LGMD (26.7%) deliveries and was a feature of chairbound patients. Considering a possible influence of pregnancy on the disease course, about half of LGMD, one-third of SMA, and one fifth of CMT patients reported a deterioration of symptoms in pregnancy. Neonatal outcome was favorable in all NMD but DM1, where infantile morbidity and mortality is often but not exclusively related to congenitally affected children. CONCLUSION Our data are important for obstetric care and genetic counseling of women with NMD who are contemplating pregnancy.
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Affiliation(s)
- Carina Awater
- Institute of Human Genetics, Medical Faculty, RWTH Aachen, Germany
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Norwood F, Rudnik-Schöneborn S. 179th ENMC international workshop: pregnancy in women with neuromuscular disorders 5-7 November 2010, Naarden, The Netherlands. Neuromuscul Disord 2011; 22:183-90. [PMID: 21689937 DOI: 10.1016/j.nmd.2011.05.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2011] [Indexed: 10/18/2022]
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Bollag L, Kent C, Richebé P, Landau R. Anesthetic management of spinal muscle atrophy type II in a parturient. Local Reg Anesth 2011; 4:15-20. [PMID: 22915887 PMCID: PMC3417967 DOI: 10.2147/lra.s17089] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
We report the peripartum management of a 30-year-old wheelchair-bound nullipara woman with spinal muscular atrophy (SMA) type II, including severe restrictive lung disease and Harrington rods. At 38 weeks gestation, she was admitted for an induction of labor with neuraxial analgesia, but she subsequently had to be delivered via cesarean section under general anesthesia. We describe the anesthetic implications of SMA on labor and delivery management and review the available literature.
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Affiliation(s)
- Laurent Bollag
- Department of Anesthesiology and Pain Medicine, University of Washington Medical Center, Seattle, WA, USA
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Howarth L, Glanville T. Management of a pregnancy complicated by type III spinal muscular atrophy. BMJ Case Rep 2011; 2011:2011/feb17_1/bcr1020103402. [PMID: 22707496 DOI: 10.1136/bcr.10.2010.3402] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The authors report the successful management of a pregnancy in a patient with spinal muscular atrophy (SMA) type III. It is a genetically inherited condition causing increasing weakness of the skeletal muscle. The patient in our case was confined to a wheelchair due to marked weakness in her lower limbs. A review of the available literature identified potential risk factors for the antenatal, intrapartum and postpartum period. These include increased risk of thromboembolism, urinary tract infections, intrauterine growth restriction and preterm delivery, anaesthetic problems and increased risk of uterine atony with subsequent postpartum haemorrhage. The authors report the management of these risk factors and the reasons for delivery by Caesarean section at 32 weeks. Apart from a decline in muscle function postdelivery requiring physiotherapy, there were no adverse outcomes for mother or baby. In both this case and on review of the literature, it is proven that a successful pregnancy is possible with SMA.
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Affiliation(s)
- L Howarth
- Department of Obstetrics and Gynaecology, St James's University Hospital, Leeds, West Yorkshire, UK.
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