Date of Award


Document Type

Independent Study

Degree Name

Master of Science (MS)


The obstetrical patient with pre-existing Multiple Sclerosis (MS) presents the Certified Registered Nurse Anesthetist (CRNA) with specific concerns regarding anesthetic management. The physiological and pathophysiological changes of pregnancy and of the disease process itself must be taken into consideration. Despite a lack of controlled studies to support clinical practice, CRNAs have traditionally avoided regional anesthesia in these patients due to the fear of disease relapse or because of legal concerns. Several authors have attempted to link regional anesthesia to MS relapse in the obstetrical patient, however no research has shown a direct link between any anesthetic technique and an increase in exacerbation of MS. Regional anesthesia, however, has several advantages over general anesthesia and other pain relief methods for the laboring patient.

The purpose of this independent project was to explore the anesthetic considerations that must be taken into account for the obstetrical patient with MS. A comprehensive understanding of the physiology of pregnancy and the pathophysiology of MS is of vital importance for CRNAs so that they may provide safe anesthetic management to this population of patients. This information, along with a discussion regarding a comprehensive literature review, was presented to Registered Nurse Anesthetists and students in training. The ultimate objective of the presentation was to enhance the knowledge base and comfort level of practitioners providing anesthesia for the obstetrical MS patient

The comprehensive literature review was made up of one large prospective study, retrospective reviews, current guidelines, and case reports. The findings were collected and a power point presentation was presented. The power point displayed the review of published data for obstetrical MS patients, which does not contraindicate the use of regional anesthesia for labor including cesarean section or vaginal delivery. The physiologic framework of pregnancy was used as the theoretical basis for the project

Overall, anesthetists need to take into consideration that it is important to inform the patient that a high incidence of disease relapse is present during the postpartum period, regardless of the choice of anesthesia and the mode of delivery