Study of the relationship between epidural anesthesia and cesarean delivery and relapse in patients with multiple sclerosis At the end of last year, Italian scholars published a research paper aimed at evaluating the impact of epidural anesthesia and cesarean delivery on the risk of postpartum relapse and disability in female patients with multiple sclerosis. From 2002 to 2008, a total of 423 pregnancies in 415 patients were registered in 21 MS centers in Italy. Of these pregnancies, 349 were full-term deliveries with a postpartum follow-up of at least 1 year. A total of 65 (18.5%) patients underwent epidural anesthesia and 155 (44.4%) patients underwent cesarean section. Multifactorial analysis showed that neither epidural anesthesia nor cesarean section increased the risk of postpartum recurrence, whereas severe disability at the time of conception was associated with recurrence, with a greater risk of recurrence before and during pregnancy. In addition, epidurals and cesarean sections do not accelerate the development of postpartum disability. However, recurrence within 1 year postpartum may exacerbate disability progression. The investigators concluded that epidural anesthesia and cesarean delivery are not associated with postpartum relapse and disability progression and can be safely performed in patients with multiple sclerosis. Postpartum relapse can accelerate disability progression; therefore, postpartum relapse prevention treatment is needed. In 2004 and 2006, French scholars and others published a similar study that included 254 patients with multiple sclerosis in 12 European countries with 269 pregnancies and follow-up until the end of the second postpartum year. RESULTS: The relapse rate decreased during pregnancy compared to the first year of pregnancy, and was lowest especially in the last trimester of pregnancy. In contrast, the relapse rate increased significantly in the first postpartum trimester. The second postpartum trimester was not different from the pre-pregnancy period. In addition, a total of one-third of patients experienced one postpartum relapse, and pregnancy did not exacerbate disability progression. Patients whose disease fluctuated before and during pregnancy were prone to recurrence in the first postpartum trimester. Breastfeeding and epidural anesthesia were not associated with postpartum recurrence. Appropriate preventive treatment modalities can reduce postpartum recurrence. Earlier studies focusing on this problem began in the 1980s, when Israeli scholars published their paper in 1984, enrolling 338 patients with 85 relapses in 199 pregnancies, 65 occurring in the postpartum period and only 2 relapses in the last trimester of pregnancy. The average relapse rate per person per year in Israeli patients with multiple sclerosis was 0.28, compared to a reduced rate of 0.04 in the last trimester of pregnancy and an increased rate of 0.82 in the first trimester of the postpartum period.This phenomenon of remission during pregnancy and relapse after delivery is similar to that of other autoimmune diseases. Subsequently, Australian and British scholars, who published similar studies, observed a high relapse rate in the postpartum period. Note: There is less information on this in China. Our case-study suggests that patients can become pregnant under stable conditions, with no relapse of the disease and no progression of disability if proper measures are taken. Even if there is a recurrence during pregnancy, with appropriate treatment measures, both mother and baby can be safe. I have learned a lot of knowledge and experience by casually reviewing foreign literature on hematological diseases, oncology and rheumatology. For example, the preparation for pregnancy, which drugs need to be stopped, which drugs can be used during pregnancy, how to deal with the disease if it relapses, etc. Therefore, we believe that demyelinating disease should not be a reason to give up childbirth in patients with fertility.