Peri-partum Respiratory Management of Pregnant Women with Neuro-muscular Disorders: a Prospective Observational Study (IT-NEUMA-Pregn Study)

Overview

Journal BMC Anesthesiol

Publisher Biomed Central

Specialty Anesthesiology

Date 2023 Oct 13

PMID 37833635

Authors

Fabrizio Racca

Yaroslava Longhitano

Christian Zanza

Mario Giosue Balzanelli

Gaetano Draisci

Paolo Augusto Stoia

Evelina Gollo

Mariella Maio

Claudia Grattarola

Marinella Astuto

Antonello Ciccarelli

Giulia Racca

Tatsiana Romenskaya

Benedetta Giordano

Alessandra Serraino

Valeria Ada Maria Sansone

Cesare Gregoretti

Giorgio Conti

Fabio Piccolella

Rosanna Vaschetto

Affiliations

Soon will be listed here.

Abstract

Background: Pregnant women with neuromuscular diseases (NMDs) often display respiratory muscle impairment which increases the risk for pulmonary complications (PCs). The aim of this study was to identify pregnant NMDs patients with pulmonary risk factors and to apply in these women non-invasive ventilation (NIV) combined with mechanical insufflation-exsufflation (MI-E) in the peri-partum period.

Methods: We conducted a multicenter observational study on women with NMDs undergoing cesarean section or spontaneous labor in a network of 7 national hospitals. In these subjects we applied a protocol for screening and preventing PCs, and we evaluated PCs rate, maternal and neonatal outcome.

Results: Twenty-four patients out of the 94 enrolled pregnant women were at risk for PCs and were trained or retrained to use NIV and/or MI-E before delivery. After delivery, 17 patients required NIV with or without MI-E. Despite nine out of the 24 women at pulmonary risk developed postpartum PCs, none of them needed reintubation nor tracheostomy. In addition, the average birth weight and Apgar score were normal. Only one patient without pulmonary risk factors developed postpartum PCs.

Conclusion: This study showed the feasibility of applying a protocol for screening and treating pregnant NMDs women with pulmonary risk. Despite a PCs rate of 37% was observed in these patients, maternal and neonatal outcome were favorable.

Citing Articles

Anesthesia for pregnant patients with symptomatic neurological disease: 13 years' experience from a tertiary care center.

Catarci S, Zanfini B, Scorzoni M, De Martino S, Giuri P, Frassanito L BMC Anesthesiol. 2025; 25(1):32.

PMID: 39833679 PMC: 11744999. DOI: 10.1186/s12871-024-02871-5.

Extra-Corporeal Membrane Oxygenation in Pregnancy.

Romenskaya T, Longhitano Y, Mahajan A, Savioli G, Voza A, Tesauro M J Clin Med. 2024; 13(6).

PMID: 38541861 PMC: 10971170. DOI: 10.3390/jcm13061634.

References

Finkel R, Sejersen T, Mercuri E . 218th ENMC International Workshop:: Revisiting the consensus on standards of care in SMA Naarden, The Netherlands, 19-21 February 2016. Neuromuscul Disord. 2017; 27(6):596-605. DOI: 10.1016/j.nmd.2017.02.014. View

Sansone V, Gagnon C . 207th ENMC Workshop on chronic respiratory insufficiency in myotonic dystrophies: management and implications for research, 27-29 June 2014, Naarden, The Netherlands. Neuromuscul Disord. 2015; 25(5):432-42. DOI: 10.1016/j.nmd.2015.01.011. View

Norwood F, Rudnik-Schoneborn S . 179th ENMC international workshop: pregnancy in women with neuromuscular disorders 5-7 November 2010, Naarden, The Netherlands. Neuromuscul Disord. 2011; 22(2):183-90. DOI: 10.1016/j.nmd.2011.05.009. View

Soma-Pillay P, Nelson-Piercy C, Tolppanen H, Mebazaa A . Physiological changes in pregnancy. Cardiovasc J Afr. 2016; 27(2):89-94. PMC: 4928162. DOI: 10.5830/CVJA-2016-021. View

Longhitano Y, Zanza C, Romenskaya T, Saviano A, Persiano T, Leo M . Single-Breath Counting Test Predicts Non-Invasive Respiratory Support Requirements in Patients with COVID-19 Pneumonia. J Clin Med. 2022; 11(1). PMC: 8745879. DOI: 10.3390/jcm11010179. View

LoMauro A, Aliverti A . Respiratory physiology of pregnancy: Physiology masterclass. Breathe (Sheff). 2016; 11(4):297-301. PMC: 4818213. DOI: 10.1183/20734735.008615. View

Guidon A, Massey E . Neuromuscular disorders in pregnancy. Neurol Clin. 2012; 30(3):889-911. DOI: 10.1016/j.ncl.2012.04.002. View

Flunt D, Andreadis N, Menadue C, Welsh A . Clinical commentary: obstetric and respiratory management of pregnancy with severe spinal muscular atrophy. Obstet Gynecol Int. 2009; 2009:942301. PMC: 2778181. DOI: 10.1155/2009/942301. View

Foster R, Boothroyd K . Caesarean section in a complicated case of central core disease. Anaesthesia. 2008; 63(5):544-7. DOI: 10.1111/j.1365-2044.2007.05411.x. View

10.

Awater C, Zerres K, Rudnik-Schoneborn S . Pregnancy course and outcome in women with hereditary neuromuscular disorders: comparison of obstetric risks in 178 patients. Eur J Obstet Gynecol Reprod Biol. 2012; 162(2):153-9. DOI: 10.1016/j.ejogrb.2012.02.020. View

11.

Johnson N, Hung M, Nasser E, Hagerman K, Chen W, Ciafaloni E . The Impact of Pregnancy on Myotonic Dystrophy: A Registry-Based Study. J Neuromuscul Dis. 2016; 2(4):447-452. PMC: 5240614. DOI: 10.3233/JND-150095. View

12.

Birnkrant D, Panitch H, Benditt J, Boitano L, Carter E, Cwik V . American College of Chest Physicians consensus statement on the respiratory and related management of patients with Duchenne muscular dystrophy undergoing anesthesia or sedation. Chest. 2007; 132(6):1977-86. DOI: 10.1378/chest.07-0458. View

13.

Racca F, Mongini T, Wolfler A, Vianello A, Cutrera R, Del Sorbo L . Recommendations for anesthesia and perioperative management of patients with neuromuscular disorders. Minerva Anestesiol. 2013; 79(4):419-33. View

14.

Islander G . Anesthesia and spinal muscle atrophy. Paediatr Anaesth. 2013; 23(9):804-16. DOI: 10.1111/pan.12159. View

15.

Bach J, Sabharwal S . High pulmonary risk scoliosis surgery: role of noninvasive ventilation and related techniques. J Spinal Disord Tech. 2005; 18(6):527-30. DOI: 10.1097/01.bsd.0000154457.62714.4b. View

16.

Racca F, Longhitano Y, Wolfler A, Carfagna F, Grattarola C, Serio P . Perioperative management of children with neuromuscular disorders based on a common protocol: A prospective, national study in Italy. Acta Anaesthesiol Scand. 2021; 65(9):1195-1204. DOI: 10.1111/aas.13844. View

17.

Bach J . Successful pregnancies for ventilator users. Am J Phys Med Rehabil. 2003; 82(3):226-9. DOI: 10.1097/01.PHM.0000053395.41165.73. View

18.

Yim R, Kirschner K, Murphy E, Parson J, Winslow C . Successful pregnancy in a patient with spinal muscular atrophy and severe kyphoscoliosis. Am J Phys Med Rehabil. 2003; 82(3):222-5. DOI: 10.1097/01.PHM.0000046621.00871.30. View

19.

Allen T, Maguire S . Anaesthetic management of a woman with autosomal recessive limb-girdle muscular dystrophy for emergency caesarean section. Int J Obstet Anesth. 2007; 16(4):370-4. DOI: 10.1016/j.ijoa.2007.03.003. View

20.

Kock-Cordeiro D, Brusse E, van den Biggelaar R, Eggink A, van der Marel C . Combined spinal-epidural anesthesia with non-invasive ventilation during cesarean delivery of a woman with a recent diagnosis of amyotrophic lateral sclerosis. Int J Obstet Anesth. 2018; 36:108-110. DOI: 10.1016/j.ijoa.2018.06.001. View