Case report
Combined spinal-epidural anesthesia with non-invasive ventilation during cesarean delivery of a woman with a recent diagnosis of amyotrophic lateral sclerosis

https://doi.org/10.1016/j.ijoa.2018.06.001Get rights and content

Highlights

  • Non-invasive ventilation for a woman with amyotrophic lateral sclerosis and respiratory failure.

  • Cesarean delivery conducted under combined spinal-epidural anesthesia.

  • A multidisciplinary approach resulted in a safe outcome.

Abstract

Amyotrophic lateral sclerosis is the most common neurodegenerative upper and lower motor neuron disease in adults but is not common in women of child-bearing age. We present a case of a pregnant woman who was diagnosed with amyotrophic lateral sclerosis and developed respiratory distress at 32 weeks-of-gestation. She underwent a cesarean delivery under combined spinal-epidural anesthesia with non-invasive ventilation. This resulted in a successful outcome for both the mother and the baby.

Section snippets

Case report

A 25-year-old woman (G2P1) was diagnosed at 27 weeks-of-gestation with clinically definite amyotrophic lateral sclerosis (ALS), according to the revised El Escorial electrophysiological criteria.1 She was referred to the obstetrician for assessment of her pregnancy and to discuss the implications of ALS and delivery. Her previous pregnancy had been uneventful and she had a spontaneous vaginal delivery. At 28 weeks-of-gestation she was seen in consultation by an obstetrician and

Discussion

Respiratory deterioration in our patient with ALS at 32 weeks-of-gestation resulted in the decision to support her respiratory status with NIV and to perform a cesarean delivery. This resulted in a successful outcome. The largest series of ALS in pregnancy was published in 1956 and consisted of 17 women from Guam.2 Since then there have been a few case reports. It is still unclear whether pregnancy influences the course of ALS or vice versa. In a review by Kawamichi et al. it was concluded that

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