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Familial hypokalemic periodic paralysis and Wolff-Parkinson-White syndrome in pregnancy

Jane E. Robinson , MBBS FRCA^*, Valerie I. Morin , MD FRCSC, M. Joanne Douglas , MD FRCSC^* and R. Douglas Wilson , MD MSC FRCSC

^* From the Departments of Anesthesia and
Obstetrics and Gynecology, British Columbia Women's Hospital & Health Centre, 4500 Oak Street, Vancouver, B.C., V6H 3N1 Canada.

Dr Joanne Douglas, Department of Anesthesia, B.C. Women's Hospital, 4500 Oak Street, Vancouver, B.C. V6H 3N1 Canada. Phone: 604-875-2158; Fax: 604-875-2733; E-mail: jdouglas{at}cw.bc.ca

Purpose: To describe the anesthetic and obstetrical management of a pregnant patient with co-existing Familial Hypokalemic Periodic Paralysis (FHPP) and Wolff-Parkinson-White syndrome (WPW).

Clinical Features: A 29 yr-old primigravida with FHPP and WPW presented to the antenatal clinic at 18 wk gestation, for consideration of her anesthetic and obstetrical management during labour and delivery. A plan was constructed to avoid the known precipitating factors of FHPP including carbohydrate loading, cold, mental stress and exercise, which could lead to acute attacks of weakness. She presented for induction of labour at 41 wk and three days. An epidural catheter was sited early in labour. The second stage was limited to less than one hour. She had a rotational forceps delivery for which the epidural was extended to provide anesthesia. A healthy male baby was delivered. The patient made an uncomplicated recovery and was discharged home on the second postnatal day. The peripartum potassium was kept within the normal range with intravenous as well as oral potassium supplementation. No arrhythmias were reported.

Conclusion: Assessment of the patient at an early stage in her pregnancy allowed for a multidisciplinary approach to this patient and her medical problems. A plan was made to avoid known precipitating factors during labour, delivery and the postnatal period well in advance of her date of confinement, leading to a successful outcome for mother and child.

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