[A case of caesarean section in a patient with myasthenia gravis: crisis was successfully avoided by preoperative plasmapheresis].

Myasthenia gravis (MG) is an autoimmune disease characterized by muscle weakness and fatigability. Women with MG have increased risk of pregnancy-related complications and an adverse pregnancy outcome. Maternal changes in pregnancy can also affect MG. The course of the disease in pregnancy is unpredictable. Delivery via caesarean section is very stressful and may cause severe myasthenic crisis. Therefore, if caesarean section is selected, coordinated management by a gynecologist, a neurologist and an anesthesiologist is necessary. We describe a 30-year-old woman with MG diagnosed during pregnancy. She was hospitalized on 33rd gestational week and was planned for delivery via caesarian section at 37th gestational week. In addition to her usual medications, we performed plasmapheresis to improve her condition for the operation not with fresh frozen plasma but with albumin solution just before the operation. No obvious abnormality of coagulation system was observed, and combined spinal and epidural anesthesia was performed with no adverse outcome. We managed her perioperative period free from myasthenic crisis.