Learning Objectives
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Describe the pathophysiology of myasthenia gravis.
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Identify pregnancy-related risks of myasthenia gravis.
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Describe management of a myasthenic crisis.
Pathophysiology
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Autoimmune disease resulting from antibodies against the acetylcholine receptor or muscle-specific kinase
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When antibodies bind to acetylcholine receptor, it blocks muscle contraction and results in weakness of skeletal muscles
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Antibodies frequently result from the presence of a thymoma
Signs and Symptoms
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Fatigable, painless muscle weakness
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Double vision and ptosis ( Fig. 26.1 ) are common
Fig. 26.1
Myasthenia gravis results in bilateral ptosis.
Technical and nontechnical skills for management of myasthenia gravis.
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Often difficulty with chewing, swallowing
Simulation Checklist
Time
Comments
Recognize
Recognized maternal respiratory distress
Recognized risk factors in clinical history
Call for help
Summoned appropriate help urgently
Called for experienced help, especially anesthesiologist
Airway, breathing
Intubation performed
Mechanical ventilation initiated
Delivery
Assisted second stage performed
Documentation
Timing of events
Persons present
Communication
Directed communication
Closed-loop communication
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