Guillain Barre Syndrome and its relapse in consecutive pregnancy

A report describes a case of a 26-year-old female, primigravida, at 32 weeks of gestation, who presented with a complaint of difficulty in walking and getting out of bed for the last two days. She also experienced weakness in both the upper limbs and difficulty in gripping since one day. However, the weakness started a week before. 

Her general physical, abdominal, Neurological, and cranial nerve examinations were unremarkable. The patient displayed all the features of flaccid quadriparesis with a power of 2/5 and 3/5 in lower and upper limbs, respectively. She had reduced muscle tone; absence of deep tendon reflexes and flexor planter reflex. She showed no sensory impairment or bowel and bladder involvement. 

After admission, her condition deteriorated with difficulty in swallowing, dysarthria, and respiratory muscle paralysis, and she needed ventilatory support. Guillain Barre Syndrome(GBS) was suspected, and further investigations were requested. CSF examination showed albumin-cytological dissociation along with an elevated protein content and a normal mononuclear leukocyte count, suggesting the diagnosis of GBS. Nerve conduction studies showed evolving multifocal demyelinating polyneuropathy, which also indicated GBS. 

The patient received intravenous steroids. However, her condition kept deteriorating. Hence, she was administered IVIG, to which she responded after the first cycle. Further, the course leads to a decrease in aortocaval compression, improvement in uteroplacental blood flow, and reduction in the risk of minimizing bed sores. The patient also received regular physiotherapy to prevent contractures and muscle wasting; prophylactic antibiotics; antithrombotic; enteral nutrition and pressure stockings. She completely recovered within two weeks. 

The patient experienced spontaneous leaking per vaginum followed by labor pains and had a normal vaginal delivery at 37 weeks. The baby showed no signs of birth asphyxia or neurological deficit. She received a discharge on the 39th day.

Three years after the first delivery, the patient again got pregnant and presented at 24 24-week periods of gestation with weakness in both lower limbs for three days. She was diagnosed with a relapse of GBS and managed with IVIG and supportive care and received a discharge after 19 days. She delivered a healthy baby vaginally at 39 weeks of gestation. 

Garg D, Gupta A, Pandit AK. Relapse Of Guillain Barre Syndrome In Consecutive Pregnancy: A Rare Occurrence. Indian Obstetrics & Gynaecology.2023;13(3).