Management of Cramp Fasciculation Syndrome During Childbirth: A Case Report Public Deposited

Thomas Bartlett, BA; Jayne Manigrasso, MD; Brandon Togioka, MD

Cramp Fasciculation Syndrome (CFS) is a rare condition provoked by abnormal excitability of peripheral neurons. CFS has been managed with medications that reduce nerve excitability or immunosuppressive therapy. However, formal recommendations regarding management of labor in patients with CFS are lacking. This report presents a case of successful management of CFS during an otherwise normal vaginal delivery in a patient with Celiac disease. In the antepartum setting, the anesthesia provider planned to give an intravenous infusion of immunoglobulin 1g/kg and intramuscular (IM) valium 2.5mg in the event of CFS during labor. Additionally, malignant hyperthermia (MH) precautions were taken in the event of fasciculation complications. The patient had the completion of a normal vaginal delivery requiring IM valium and an early bupivacaine epidural. She was discharged at the end of a four-day hospitalization. Over and under preparing for CFS has consequences from a morbidity and resource utilization standpoint. This case report was created to guide clinical decision-making for obstetric and anesthesia providers who encounter a pregnant patient with a history of CFS.

Publication Date
  • 2022-04-18
Document type