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

Purpose: To describe the anesthetic and obstetrical management of a pregnan t patient with co-existing Familial Hypokalemic Periodic Paralysis (FHPP) a nd 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 anestheti c and obstetrical management during labour and delivery. A plan was constru cted to avoid the known precipitating factors of FHPP including carbohydrat e loading, cold. mental stress and exercise, which could lead to acute atta cks of weakness. She presented for induction of labour at 41 wk and three d ays. An epidural catheter was sited early in labour. The second stage was l imited to less than one hour. She had a rotational forceps delivery for whi ch the epidural was extended to provide anesthesia. A healthy male baby was delivered. The patient made an uncomplicated recovery and was discharged h ome on the second postnatal day. The peripartum potassium was kept within t he 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 al lowed for a multidisciplinary approach to this patient and her medical prob lems. A plan was made to avoid known precipitating factors during labour, d elivery and the postnatal period well in advance of her date of confinement , leading to a successful outcome for mother and child.