Anesthetic management of a pregnant woman with Gorham-Stout disease.
Gorham-Stout disease is a rare disorder of bone loss and proliferation of lymphatic and vascular tissue (lymphangiomatosis). A 30-year-old nulliparous woman with Gorham-Stout disease presented at 8weeks of gestation with a fused cervical spine. At 31weeks she developed basilar invagination and neurological symptoms that were managed with a neck brace. Anesthetic considerations were those of airway compromise, development of severe preeclampsia and Kasabach-Merritt coagulopathy. Elective tracheostomy was declined. She presented two days before a planned cesarean delivery at 35weeks in preterm labor. A semi-urgent cesarean delivery under spinal anesthetic proceeded uneventfully, with an otolaryngologist present in case a surgical airway was required. Mother and baby were discharged home after three days. Maternal postpartum recovery was complicated by episodes of respiratory compromise and critical bone loss in the cervical spine, necessitating further surgical reinforcement.
Department of Anesthesiology, Sharp Mary Birch Hospital for Women and Newborns, San Diego, CA, USA. david.gambling@sharp.com
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Gambling
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Catanzarite
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J
Fisher
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Harms
D000328:Adult; D000773:Anesthesia, Obstetrical; D000775:Anesthesia, Spinal; D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D001862:Bone Resorption / Q000150:complications / Q000473:pathology; D002585:Cesarean Section; D005260:Female; D006801:Humans; D009777:Occipital Bone / Q000002:abnormalities; D010015:Osteolysis, Essential / Q000150:complications*; D010243:Paralysis / Q000209:etiology; D011225:Pre-Eclampsia / Q000628:therapy; D011247:Pregnancy; D013131:Spine / Q000601:surgery; D014057:Tomography, X-Ray Computed
D050071:Bone Density Conservation Agents