Multiple Sclerosis in Pregnancy

A 32-year-old woman attends the obstetric anaesthetic assessment clinic, having been referred by the obstetric registrar. She is 24 weeks into her first pregnancy, and has a history of multiple sclerosis. She uses a walking stick. Her other medical history includes anxiety. There are no other relevant obstetric, medical or anaesthetic issues. She had an uneventful general anaesthetic for an appendicectomy at this hospital last year for which you have the anaesthetic record. There were no airway issues. She takes escitalopram and has monthly ocrelizumab infusions, which have been withheld in pregnancy. She has no allergies. She wishes to discuss analgesia in labour and anaesthesia should a caesarean or other operative intervention be required.