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Myasthenia gravis and pregnancy
Prx ” ‘2’ Wilson, Andrew, and Barr{
J. James: Gynaec. Brit. Emp. 52: 584, 1945.
ABSTRACTS Myasthenia
351 Gravis
and Pregnancy,
J. Obst. &
In the case reported, the patient had had myasthenia gravis for eighteen months; symptoms were satisfactorily controlled by prostigmin (15 mg. three times a day) and ephedrine (s gr. twice a day). When she became pregnant, there was no change in her condition until the beginning of the second trimester, when a slight increase in the amount ‘of prostigmin was necessary (60 mg. daily). Labor was normal and delivery spontaneous; there was no evidence of any exhaustion of the voluntary musculature, and no signs of any inertia or fatigue of the uterus. There was a transient mild relapse of the myasthenia gravis, necessitating another slight increase in the dosage of prostigmin during the first five days after labor. By the fifth day, the patient’s condition was the same as in the last half of pregnancy; and on the ninth day a definite remission of the myasthenia gravis began which continued for nine months, so that symptoms were controlled by a smaller dose of prostigmin than was required before pregnancy; the patient nursed the child for seven months of this period. After this nine months, remission, the dosage was raised to the prepregnancy level for adequate maintenance. The child was normal at birth and has developed normally. This ease and a review of the literature lead the author to conclude that there is no indication that pregnancy, labor, or nursing affects the course of myasthenia gravis adversely, if the patient is adequately treated with prostigmin and ephedrine. HARVEY
Thomas,Rufus c.:
Rupture of the Rectus Abdominis Muscle During & Gynaec. Brit. Emp. 53: 580, 1945.
B. MATTHEWS.
Pregnancy,
J. Obst.
The author has previously reported a case of rupture of the rectus abdominis muscle during pregnancy, and reports a second case in this article. In this case the patient had had five previous normal pregnancies and deliveries and one abortion. She was admitted to the hospital when about 33 weeks pregnant, with a history of bronchitis and pain in the abdomen when she coughed; a “lump” had also been noticed in the region of the right rectus muscle. While a diagnosis of concealed accidental hemorrhage was made, the uterus was softer than it would be with such a hemorrhage that produced abdominal tenderness. While under observation she developed typical symptoms of internal hemorrhage, and operation was done. This showed a tear in the right rectus muscle with bleeding from a branch of the deep epigastric artery and another smaller vessel; blood clots were removed, the bleeding arteries ligatured, and a pack placed along the deep surface of the rectus muscle, and brought out through the lower end of the incision, which was then closed. On the fifth day aft,er operation, the patient was delivered of a stillborn child. The patient finally made a good recovery, which was delayed by a reaction to an incompatible blood transfusion. A review of the literature shows this to be the thirty-second ease reported of rupture of the rectus muscle during pregnancy; the correct diagnosis was made before operation in only nine of the 32 cases. Cullen’s sign was present in five of the cases, including the case reported. The maternal mortality was 13 per cent, the fetal mortality about 50 per cent. Conservative treatment is justified in these eases only if the patient’s condition remains good; if signs of increasing hemorrhage and shock develop, operation is indicated. HARVEY
B. MATTHEWS.
Riesco,A., and Rodriguez, F.: ‘Cancerof the Cervix and Pregnancy, Bol. Sot. Chilena de obst. y ginec. 10: 93-118, 1945. At the National Institute of Radium in Santiago, Chile, 33 cases of cancer of the cervix complicating pregnancy were observed. This represented an incidence of 0.31 per 1,000 pregnancies. The most frequent age of the patients was between 28 and 30 years. The patients were seen on an average of four months after the onset of symptoms. In 21 per cent the patients had Group I cancer. In 93 per cent of the cases, the carcinoma was of the squamous-cell type. Labor was premature in 27.3 per cent, and a similar number had Among the 19 cases of abortion or delivery through the vagina, the incidence abortions.
J. James: Gynaec. Brit. Emp. 52: 584, 1945.
ABSTRACTS Myasthenia
351 Gravis
and Pregnancy,
J. Obst. &
In the case reported, the patient had had myasthenia gravis for eighteen months; symptoms were satisfactorily controlled by prostigmin (15 mg. three times a day) and ephedrine (s gr. twice a day). When she became pregnant, there was no change in her condition until the beginning of the second trimester, when a slight increase in the amount ‘of prostigmin was necessary (60 mg. daily). Labor was normal and delivery spontaneous; there was no evidence of any exhaustion of the voluntary musculature, and no signs of any inertia or fatigue of the uterus. There was a transient mild relapse of the myasthenia gravis, necessitating another slight increase in the dosage of prostigmin during the first five days after labor. By the fifth day, the patient’s condition was the same as in the last half of pregnancy; and on the ninth day a definite remission of the myasthenia gravis began which continued for nine months, so that symptoms were controlled by a smaller dose of prostigmin than was required before pregnancy; the patient nursed the child for seven months of this period. After this nine months, remission, the dosage was raised to the prepregnancy level for adequate maintenance. The child was normal at birth and has developed normally. This ease and a review of the literature lead the author to conclude that there is no indication that pregnancy, labor, or nursing affects the course of myasthenia gravis adversely, if the patient is adequately treated with prostigmin and ephedrine. HARVEY
Thomas,Rufus c.:
Rupture of the Rectus Abdominis Muscle During & Gynaec. Brit. Emp. 53: 580, 1945.
B. MATTHEWS.
Pregnancy,
J. Obst.
The author has previously reported a case of rupture of the rectus abdominis muscle during pregnancy, and reports a second case in this article. In this case the patient had had five previous normal pregnancies and deliveries and one abortion. She was admitted to the hospital when about 33 weeks pregnant, with a history of bronchitis and pain in the abdomen when she coughed; a “lump” had also been noticed in the region of the right rectus muscle. While a diagnosis of concealed accidental hemorrhage was made, the uterus was softer than it would be with such a hemorrhage that produced abdominal tenderness. While under observation she developed typical symptoms of internal hemorrhage, and operation was done. This showed a tear in the right rectus muscle with bleeding from a branch of the deep epigastric artery and another smaller vessel; blood clots were removed, the bleeding arteries ligatured, and a pack placed along the deep surface of the rectus muscle, and brought out through the lower end of the incision, which was then closed. On the fifth day aft,er operation, the patient was delivered of a stillborn child. The patient finally made a good recovery, which was delayed by a reaction to an incompatible blood transfusion. A review of the literature shows this to be the thirty-second ease reported of rupture of the rectus muscle during pregnancy; the correct diagnosis was made before operation in only nine of the 32 cases. Cullen’s sign was present in five of the cases, including the case reported. The maternal mortality was 13 per cent, the fetal mortality about 50 per cent. Conservative treatment is justified in these eases only if the patient’s condition remains good; if signs of increasing hemorrhage and shock develop, operation is indicated. HARVEY
B. MATTHEWS.
Riesco,A., and Rodriguez, F.: ‘Cancerof the Cervix and Pregnancy, Bol. Sot. Chilena de obst. y ginec. 10: 93-118, 1945. At the National Institute of Radium in Santiago, Chile, 33 cases of cancer of the cervix complicating pregnancy were observed. This represented an incidence of 0.31 per 1,000 pregnancies. The most frequent age of the patients was between 28 and 30 years. The patients were seen on an average of four months after the onset of symptoms. In 21 per cent the patients had Group I cancer. In 93 per cent of the cases, the carcinoma was of the squamous-cell type. Labor was premature in 27.3 per cent, and a similar number had Among the 19 cases of abortion or delivery through the vagina, the incidence abortions.