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. - •
Often difficulty with chewing, swallowing
Simulation ChecklistTime 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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