Central pontine myelinolysis during pregnancy: Pathogenesis, diagnosis and management.

María Luisa Sánchez-Ferrer, María Teresa Prieto-Sánchez, Rodrigo Orozco-Fernández, Francisco Machado-Linde, Anibal Nieto-Diaz

Journal: Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology 2017;37(3):273-279

PMID: 27922286

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Abstract

Central pontine myelinolysis (CPM) is a rare condition usually caused by rapid sodium correction in hyponatraemia after a severe neurological syndrome. Only few cases have been reported during pregnancy, most of which were reported in patients with hyperemesis. We describe the successful management of the first case of twin pregnancy in a patient who presented with CPM after treatment for premature labour and then review the literature on CPM in pregnancy (aetiology, diagnosis and management). Our patient required emergency delivery to achieve electrolyte and fluid balance. At six months, the twins remained asymptomatic and the mother had minor sequelae. The aetiology is not clear, and there is no evidence regarding the optimal treatment or prognosis of CPM. In our patient, desmopressin-contaminated atosiban showed a certain probability in the Karch-Lasagne algorithm of a causality relationship between hyponatraemia and the drug. To our knowledge, this is the first case of myelinolysis reported in a twin pregnancy possibly related to desmopressin-contaminated atosiban.

Address: a Obstetrics and Gynaecology Department , Virgen de la Arrixaca Clinical Hospital, University of Murcia , Murcia , Spain.

DOI: 10.1080/01443615.2016.1244808

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MeSH Terms: Adult, Antidiuretic Agents, Antiemetics, Brain, Cesarean Section, Deamino Arginine Vasopressin, Dexamethasone, Drug Contamination, Female, Humans, Hyponatremia, Infant, Newborn, Magnetic Resonance Imaging, Myelinolysis, Central Pontine, Obstetric Labor, Premature, Pregnancy, Pregnancy, Twin, Tocolytic Agents, Ultrasonography, Prenatal, Vasotocin, Water-Electrolyte Balance