International Journal of Healthcare Sciences ISSN 2348-5728 (Online) Vol. 8, Issue 2, pp: (329-335), Month: October 2020 - March 2021, Available at: www.researchpublish.com
CHALLENGES IN CAESAREAN SECTION UNDER SPINAL ANAESTHESIA TO A WOMAN WITH MULTIPLE SCLEROSIS: CASE REPORT AND LITERATURE REVIEW Thirukumar Markandu 1, S Mathanalagan 2, V.Thadchanamoorthy3 1
Senior Lecturer in Obstetrics and Gynaecology, Department of Clinical Science, Faculty of Health Care Sciences, Eastern University, Sri Lanka, 2
Consultant Anaesthetist, Teaching Hospital, Batticaloa,
3
Senior Lecturer in Paediatrics, Department of Clinical Science, Faculty of Health Care Sciences, Eastern University, Sri Lanka Correspoding Author Dr.M. Thirukumar dr.thiru10@yahoo.com Orcid number; 0000-0001-8499-7175
Abstract: A 29-year-old primigravida woman with multiple sclerosis (MS) underwent caesarean section under spinal anaesthesia with the consultation of multidisciplinary team care involving Aanaesthetist, Obstetrician, Neonatologist, and Neurologist. The spinal anaesthesia was given following a lengthy discussion with her and her supportive husband. She had neither intraoperative nor immediate postoperative complications because of anaesthesia. No disease relapse or remission occurred in the 6months postpartum period. We used Pubmed, Medline, and Embase for literature with the aim to improve the management of spinal anaesthesia in patients with multiple sclerosis. Keywords: Cesarean section, spinal anaesthesia, multiple sclerosis.
1. INTRODUCTION MS is a demyelinating condition of the central nervous system (CNS) mainly prevalent and causes neurological disability in young women in their 20-40 years of age in Western countries. It has uncertain aetiology with diverse clinical presentation, therefore, arriving at a diagnosis is difficult [1]. The pathological hallmark of MS is perivascular inflammation and demyelination. Plaques are also other pathological feature of MS which can be demonstrated in the white matter of the CNS, mostly in optic nerves, brainstem, cerebellum, and spinal cord. The clinical symptom correlates with the location of plaque [2]. In Sri Lanka, its exact prevalence rate is uncertain as MS is poorly studied. However, certain studies on MS in the South Asian region, reported its prevalence is considerably low in Sri Lanka, and its clinical picture is also different from other parts of the world [3].
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