Abstract
ObjectivesMultiple sclerosis (MS) often occurs in young women and the effect of obstetric anesthesia/analgesia on the disease is poorly understood. No previous study has investigated the course of the disease in women in labor in the Czech Republic. The aim of this study was to evaluate the occurrence or absence of relapses in the 6‐month postpartum period in MS parturients with and without obstetric anesthesia/analgesia.Materials and MethodsWe retrospectively studied all deliveries (n = 58,455) at the University Hospital Brno from 2004 to 2013 and identified those of the women with an ICD‐10 code G35 (MS) recorded anytime in their medical history (n = 428). We included only deliveries of women with confirmed diagnosis at the time of labor (n = 70). Statistical analysis was performed using the Fischer Exact Test.ResultsThere were 70 deliveries of 65 women, including 45 vaginal deliveries and 25 Cesarean deliveries (16 under general anesthesia, 8 with epidural anesthesia and 1 with spinal anesthesia). Epidural obstetric analgesia was performed in 11 deliveries. There was no statistically significant difference in relapses between the vaginal delivery group (n = 15; 33%) and Cesarean section group (n = 10; 40%), p = 0.611.ConclusionNeither delivery mode (vaginal vs Caesarean) nor type of obstetric anesthesia/analgesia was found to have any impact on the course of MS at 6 months postpartum in women with this condition.
Highlights
The prevalence of multiple sclerosis (MS) is 160 per 100,000 individuals in the Czech Republic (Vachova, 2012) and affects women two to three times more than men (Sellner et al, 2011)
The base-line characteristics of parturients are shown in Table 2, we found no statistically significant differences between groups of vaginal delivery and C-section
There were no significant differences in relapse occurrence (RO) 6 months after delivery between groups with C-section in general anesthesia (GA) and C-section in regional anesthesia (RA)
Summary
The prevalence of multiple sclerosis (MS) is 160 per 100,000 individuals in the Czech Republic (Vachova, 2012) and affects women two to three times more than men (Sellner et al, 2011). There is a difference in the incidence and prevalence of MS across Europe with suspected risk factors presumed to be a combination of lack of vitamin D, smoking and EBV infection together with genetic. Studies have shown that between 1/5 and 1/3 of women with MS bear children after disease onset, (Runmarker & Andersen, 1995; Weinshenker, Hader, Carriere, Baskerville, & Ebers, 1989) making the effect of maternal MS on pregnancy outcomes relevant to patients, their family members, and health care professionals (van der Kop et al, 2011). Pregnancy was discouraged in women with MS; recent studies have shown pregnancy as having a potentially beneficial role on MS relapse rates with no effects on long-term progression of the disease (Confavreux, Hutchinson, Hours, Cortinovis-Tourniaire, & Moreau, 1998; Koch, Uyttenboogaart, Heersema, Steen, & De Keyser, 2009; Vukusic et al, 2004)
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