An ever-challenging relationship: lupus and pregnancy

Bălănescu, Andra; Donisan, Teodora; Balanescu, Dinu Valentin

doi:10.5114/reum.2017.66685

Cited by 16 publications

(21 citation statements)

References 33 publications

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“…[6][7][8] It is therefore important for women with SLE to receive appropriate pre-pregnancy counseling and medication adjustments, as well as strict disease control before pregnancy and intensive surveillance during and after pregnancy. [7][8][9] In contrast, discontinuing anti-rheumatic drugs that are compatible with pregnancy is likely to have adverse outcomes. 10 In the current case, the patient discontinued prednisone during her first trimester without consulting her doctor, which might have contributed to the adverse pregnancy events and maternal outcome.…”

Section: Discussionmentioning

confidence: 99%

Pernicious placenta previa/placenta percreta complicating active systemic lupus erythematosus resulting in postoperative artery thrombosis

Liu

Zuo

et al. 2019

J Int Med Res

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Systemic lupus erythematosus (SLE) increases the risk of adverse pregnancy outcomes and fetal complications. Placenta percreta, involving placental attachment to another organ, is a rare but severe placental abnormality. We report a 26-year-old woman, G2P1, with a 6-year history of SLE with coexisting pernicious placenta previa and placenta percreta detected by second trimester ultrasound. She discontinued prednisone 5 months before admission, without consultation, and active SLE was diagnosed on admission. Because of her progressive condition, the patient underwent infrarenal abdominal aorta balloon occlusion and double J ureteral catheter placement, followed by elective cesarean at 27+6 weeks gestation. Despite aggressive management, she experienced severe bleeding requiring internal iliac artery ligation and peripartum hysterectomy. The placenta had penetrated the uterus walls and attached to the bladder apex, necessitating bladder repair. Thrombosis was detected in the common iliac artery and common femoral artery in the right leg 1 day postoperatively. Conservative antithrombotic therapy had little effect, and embolectomy by arteriotomy was performed on the 6th post-cesarean day, and an arterial thrombus was removed. Infrarenal abdominal aorta balloon occlusion may increase the risk of postoperative thrombosis in pregnant women with active SLE and coagulation disorders. These patients therefore require close monitoring and timely anticoagulation.

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Section: Discussionmentioning

confidence: 99%

Pernicious placenta previa/placenta percreta complicating active systemic lupus erythematosus resulting in postoperative artery thrombosis

Liu

Zuo

et al. 2019

J Int Med Res

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“…The onset of SLE is more frequent in the first years of reproduction, and it is advised to avoid pregnancy when the disease is active. Premature ovarian failure (persistent amenorrhea with elevated levels of follicle-stimulating hormone before age 40) may be of autoimmune etiology in the general population but is rarely associated with systemic autoimmune diseases such as SLE [1,2]. The study of anti-ovarian antibodies has contributed little to this pathology.…”

Section: Systemic Lupus Erythematosus Fertilitymentioning

confidence: 99%

“…When administered during the follicular phase of the cycle, it can stimulate the ovaries and worsen ovarian damage. Patients without therapy with GnRH agonists before their first infusion can start treatment after the first cycle and receive treatment at monthly intervals thereafter [2].…”

Section: Sle Fertility Preservationmentioning

confidence: 99%

See 1 more Smart Citation

Lupus Pregnancy: Risk Factors and Management

Ordi-Ros¹,

Marce²,

Cortés-Hernández³

2020

Lupus - New Advances and Challenges

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Systemic lupus erythematosus (SLE) mainly affects women in the fertile age of life. A patient with SLE is as fertile as the general population except for treatment with drugs with ovarian toxicity, severe flare of the disease, or autoimmune oophoritis for anti-ovarian antibodies. Pregnancy in a woman with SLE implies greater maternal and fetal mortality and morbidity. Fetal loss, premature birth, intrauterine growth restriction associated with antiphospholipid antibodies (aPL), and neonatal lupus associated with anti-Ro are important fetal problems. Similarly, preeclampsia and lupus nephritis may lead to diagnostic confusion. Treatment options during pregnancy are limited to a few safe medications, which further restricts options. The loss of refractory pregnancy associated with antiphospholipid antibodies and the complete heart block associated with anti-Ro antibodies remain unresolved problems. The planning of pregnancy with sustainable treatments during pregnancy, no flare of SLE in the previous 6 months, and absence of nephritis are important for a good maternal and fetal prognosis. A gestation planning, multidisciplinary approach, and close monitoring are essential to obtain optimal results.

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“…Even with successful conception, there is no guarantee that the ensuing pregnancy will be without problems, given that LE increases the rate of miscarriage among pregnant women by a factor of 5-20 [ 2 ] . Pregnancy is known to cause LE fl are-ups in up to 60 % of patients [ 2,3 ] , and adequate disease control prior to conception is key to a favorable pregnancy outcome [2][3][4] .…”

mentioning

confidence: 99%