Srimathy Raman

Abstract

Guillain Barre Syndrome is a rare immune mediated acute demyelinating polyradiculopathy, uncommon in pregnancy, but with increased mortality and morbidity. It poses a great diagnostic challenge. Good outcomes can be achieved in these patients with multidisciplinary team involvement. We would like to highlight the need for obstetricians to keep this rare cause in mind by describing the case report of a pregnant lady who presented to our hospital with muscle weakness and how timely diagnosis by appropriate investigations-nerve conduction studies and timely treatment with IVIG prevented complications. Key Messages: 1. Delay in diagnosis is common in pregnancy due to initial nonspecific symptoms which mimic changes in pregnancy. 2. GBS should be considered in pregnant patients presenting with weakness, tingling and numbness. 3. Early diagnosis by involving multidisciplinary team, appropriate investigations (NCS) and prompt initiation of immunomodulatory treatment improves outcomes. 4. Management in pregnancy is like that in the non-pregnant population.   Keywords: GBS, Pregnancy, Demyelinating radiculopathy, IVIG.

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Abstract

Addison’s disease is a rare endocrine disorder. We present the management of a pregnant lady with Addison’s disease. She was managed jointly with the endocrinologists and the titrated dose of hydrocortisone and fludrocortisone dosage was regulated. Her antenatal care was uneventful and she had emergency caesarean section at 39 weeks in view of abnormal CTG. Her labour was appropriately covered with rescue steroids. However she went into hypotension immediately after delivery. She was resuscitated and was managed further in ICU where high dose steroids were given. She made an uneventful recovery. Key Messages: 1. Management of pregnancy with Addison’s disease is challenging but are often achieved with appropriate multidisciplinary management; 2. Patients with Addison’s disease tolerate pregnancy well if the replacement steroids are adjusted and monitored closely; 3. Labour and delivery need to be managed cautiously with adequate steroid replacement to ensure successful outcomes; 4. Differentials need to be considered when adequate steroid cover has been provided and still there is a picture of Addisonian crisis. Keywords: Addison’s, Complications, Crisis, Pregnancy, Stress steroids

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