Guillain-Barre syndrome in pregnancy- a rare entity

Snehal W. Pakhale; Angela Sehra; Seema Bhardwaj

doi:10.18203/2320-1770.ijrcog20204846

Authors

Snehal W. Pakhale Department of Obstetrics and Gynecology, Maharaja Agrasen Hospital, Punjabi Bagh West, New Delhi, India
Angela Sehra Department of Obstetrics and Gynecology, Maharaja Agrasen Hospital, Punjabi Bagh West, New Delhi, India
Seema Bhardwaj Department of Obstetrics and Gynecology, Maharaja Agrasen Hospital, Punjabi Bagh West, New Delhi, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20204846

Keywords:

Guillain-Barre syndrome, Pregnancy, Brighton criteria, Plasmapheresis

Abstract

Guillain-Barre syndrome (GBS) is a rare, autoimmune disorder. Estimated incidence is 0.62 to 2.66 cases per 100000 people annually. We report a case of GBS in 29 years old primigravida with pre-gestational diabetes mellitus controlled on insulin, who presented at 7 weeks of the period of gestation with complaints of numbness in both hands and fingers. After 3 days of hospital admission, she had progressive weakness in both limbs and difficulty in walking. MRI of the brain and spinal cord done to exclude other possible causes and was normal. All the other blood investigations including electrolytes were normal. Nerve conduction velocity test was suggestive of acute inflammatory demyelinating axonal motor polyneuropathy and diagnosis of GBS was made. She was managed by multidisciplinary approach in intensive care unit. The patient improved after plasmapheresis and supportive measures as thromboembolism prophylaxis and physiotherapy. Patient was discharged after 2 weeks of hospital stay and had no residual symptoms after 1 month. She was readmitted at 32 weeks of gestation with severe preeclampsia and underwent emergency cesarean section delivering 1.9 kg male baby. She was discharged on day 4 of cesarean section and followed in postpartum period for complications. To summarize, GBS can appear at any stage of pregnancy & postpartum. Diagnosis can be delayed, so needs high index of clinical suspicion. Early diagnosis along with prompt intensive multidisciplinary supportive care improves outcomes for the mother and foetus.

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Author Biography

Snehal W. Pakhale, Department of Obstetrics and Gynecology, Maharaja Agrasen Hospital, Punjabi Bagh West, New Delhi, India

Clinical assistant in Obstetrics and Gynaecology department,

Maharaja Agrasen Hospital, Punjabi Bagh West, New Delhi.

References

Winer JB, Hughes RA, Anderson MJ, Jones DM, Kangro H, Watkins RP. A prospective study of acute idiopathic neuropathy. II. Antecedent events. J Neurol Neurosurg Psychiatry. 1988;51(5):613–8.

Vasudev R, Raina TR. A rare case of Guillain-Barré syndrome in pregnancy treated with plasma exchange. Asia J Transfus Scien. 2014;8(1):59.

Fokke C, van den Berg B, Drenthen J, Walgaard C, van Doorn PA, Jacobs BC. Diagnosis of Guillain-Barré syndrome and validation of Brighton criteria. Brain J Neurol. 2014;137(Pt 1):33–43.

Sharma SR, Sharma N, Masaraf H, Singh SA. Guillain-Barré syndrome complicating pregnancy and correlation with maternal and fetal outcome in North Eastern India: A retrospective study. Ann Indian Acad Neurol. 2015;18(2):215.

Meena AK, Khadilkar SV, Murthy JMK. Treatment guidelines for Guillain–Barré Syndrome. Ann Indian Acad Neurol. 2011;14(1):S73–81.

Fernando T, Ambanwala A, Ranaweera P, Kaluarachchi A. Guillain-Barré syndrome in pregnancy: A conservatively managed case. J Fam Med Prim Care. 2016 ;5(3):688.

Chan LY-S, Tsui MH-Y, Leung TN. Guillain-Barré syndrome in pregnancy. Acta Obstet Gynecol Scand. 2004;83(4):319–25.

Hahn AF. Guillain-Barré syndrome. Lance. 1998;352(9128):635–41.

Yamada H, Noro N, Kato EH, Ebina Y, Cho K, Fujimoto S. Massive intravenous immunoglobulin treatment in pregnancy complicated by Guillain–Barré Syndrome. Eur J Obstet Gynecol Reprod Biol. 2001;97(1):101–4.

Van der Meché FG, Schmitz PI. A randomized trial comparing intravenous immune globulin and plasma exchange in Guillain-Barré syndrome. Dutch Guillain-Barré Study Group. N Engl J Med. 1992;326(17):1123–9.

Hurley TJ, Brunson AD, Archer RL, Lefler SF, Quirk JG. Landry Guillain-Barré Strohl syndrome in pregnancy: report of three cases treated with plasmapheresis. Obstet Gynecol. 1991;78(2):482–5.

1Mehndiratta MM, Chowdhury D, Goel V. Efficacy and cost effectiveness of current therapies in Guillain Barre syndrome. J Assoc Physic Ind. 2001;49:459–69.

Wing EJ, Bruns FJ, Fraley DS, Segel DP, Adler S. Infectious Complications With Plasmapheresis in Rapidly Progressive Glomerulonephritis. J Americ Medic Assoc. 1980;28;244(21):2423–6.

Caudle MR, Scott JR. The Potential Role of Immunosuppression, Plasmapheresis, and Desensitization as Treatment Modalities For Rh Immunization. Clin Obstet Gynecol. 1982;25(2):313–9.

Breuer GS, Morali G, Finkelstein Y, Halevy J. A pregnant woman with hepatitis A and Guillain-Barré. J Clin Gastroenterol. 2001;32(2):179–80.

Clifton ER. Guillain-Barré syndrome, pregnancy, and plasmapheresis. J Am Osteopath Assoc. 1992;92(10):1279–82.

Zeeman GG. A case of acute inflammatory demyelinating polyradiculoneuropathy in early pregnancy. Am J Perinatol. 2001;18(4):213–5.

VG. Acute inflammatory demyelinating polyneuropathy in patients with pregnancy. Neurol Ind. 2004;52(2):283.

Bahadur A, Gupta N, Deka D, Mittal S. Successful maternal and fetal outcome of Guillain-Barré syndrome complicating pregnancy. Indian J Med Sci. 2009;63:517–8.

Meenakshi-Sundaram S, Swaminathan K, Karthik SN, Bharathi S. Relapsing Guillain-Barre syndrome in pregnancy and postpartum. Ann Indian Acad Neurol. 2014;17(3):352–4.

Zafar MSH, Naqash MM, Bhat TA, Malik GM. Guillain-Barré Syndrome in Pregnancy: An Unusual Case. J Fam Med Prim Care. 2013;2(1):90–1.