Case report of a pregnant patient with systemic lupus erythematosus with uterine atony and very thin myometrium with uterine fibrosis

Tokushige, Yu; Iwami, Shuichiro; Nonogaki, Takafumi; Shibayama, Takahiro; Shimada, Toshihide; Minamiguchi, Sachiko

doi:10.1002/ijgo.12118

Cited by 5 publications

(6 citation statements)

References 4 publications

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“…As such, the present study supports the recommendation of minimizing the total steroid dose by utilizing combined regimens with other immunosuppressive agents (17). Studies have also reported that high-dose steroids can increase the risk of placenta accreta formation and uterine myometrial brosis due to reduced estrogenic effect and endometrial thinning, potentially causing atonic bleeding and substantial blood loss (18,19). Thus, minimizing the total steroid dose whenever possible is crucial to ensure optimal outcomes for both the mother and fetus.…”

Section: Discussionsupporting

confidence: 82%

Pregnancy with Mixed Connective Tissue Disease: exploration of factors influencing live birth outcomes

Yoshida,

Takeda,

Ishii

et al. 2024

Preprint

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Background Mixed connective tissue disease (MCTD) predominantly affects women in their reproductive age (30–40 years). This study is aimed to analyze a case series of MCTD-complicated pregnancies. Methods The study design utilized a combined case-series and case-control approach. Pregnant women with MCTD were included and categorized into two groups: the live-birth group and the non-live birth group (encompassing miscarriages < 12 weeks and stillbirths ≥ 12 weeks). Primary outcomes included delivery outcomes and factors associated with live births. Results A total of 57 pregnancies from 34 mothers (median age: 33.0 years) were included. Regarding delivery outcomes, the rates for live birth, miscarriage, and stillbirth were 64.9%, 29.8%, and 5.3%, respectively. Additionally, the rates of preterm delivery, fetal growth restriction (FGR), and small-for-gestational-age (SGA) were 18.9%, 18.9%, and 27.0%, correspondingly. Regarding factors associated with live births, the live birth group demonstrated a higher prevalence and lower steroid dose usage compared to the non-live birth group (62.2% vs. 30.0%, p = 0.02; median dose: 7 mg vs. 10 mg, p = 0.03). Conclusions MCTD during pregnancy was associated with increased risks of miscarriage, stillbirth, preterm delivery, FGR, and SGA. Notably, low-dose steroid therapy has been identified as a contributing factor to successful live births.

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Section: Discussionsupporting

confidence: 82%

Pregnancy with Mixed Connective Tissue Disease: exploration of factors influencing live birth outcomes

Yoshida,

Takeda,

Ishii

et al. 2024

Preprint

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“…SLE is an autoimmune disorder that develops mainly in women of reproductive age and sometimes becomes life-threatening. 16 In addition to the known risks of perinatal events in patients with SLE, some recent reports demonstrated that cases of unresponsiveness to oxytocin 17 18 and excessive uterine atony due to a very thin myometrium 18 19 20 (both present in our patient) were observed in patients with SLE. Moreover, Noh et al reported a case of spontaneous rupture of an unscarred uterus at 23 weeks of gestation in a woman with SLE with long-term steroid treatment.…”

Section: Discussionsupporting

confidence: 52%

“…They observed uterine fibrosis in a patient with SLE who received long-term steroid treatment, and suggested that uterine fibrosis might have caused PPH in the patient. 18 In our case, the patient had taken prednisolone 5 mg/day for 11 years which was considered long-term steroid treatment.…”

Section: Discussionmentioning

confidence: 88%

“…29 30 Surprisingly, a previous report described the case of a patient in whom the B-Lynch sutures did not improve uterine atonic hemorrhage because of excessive atony and a very thin myometrium. 18 In addition, although UAE, which is less invasive than hysterectomy, has been reported to be highly effective, it has been associated with risks of severe complications, including uterine necrosis and uterine rupture. 31 32 Therefore, our less-invasive hemostatic procedures might reduce these severe complications.…”

Section: Discussionmentioning

confidence: 99%

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“Step-by-Step” Minimally Invasive Hemostatic Technique Using Intrauterine Double-Balloon Tamponade Combined with Uterine Isthmus Vertical Compression Suture for the Control of Placenta Accreta and Severe Atonic Hemorrhage during a Cesarean Section

et al. 2021

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A sudden onset of postpartum hemorrhage (PPH) during a cesarean delivery requires urgent hemostasis procedures, such as the B-Lynch, Hayman, or double-vertical compression sutures, when bimanual compression, uterotonic agent administration, and intrauterine balloon tamponade had failed to achieve sufficient hemostasis. However, after invasive hemostatic procedures, postoperative complications, including subsequent synechiae and infection followed by ischemia, have been reported to occur even in successful cases. To avoid these complications, we devised and performed a minimally invasive combined technique based on a “step-by-step” minimally invasive hemostatic protocol for a case of placenta accreta and severe atonic hemorrhage during a cesarean delivery. A nullipara woman with a history of systemic lupus erythematosus and treatment with prednisolone and tacrolimus underwent a cesarean section because of a nonreassuring fetal status. Severe atonic hemorrhage and placenta accreta were observed which did not respond to bimanual compression and uterotonics. Because severe uterine atony and continuous bleeding from the placental attachment area were observed even with intrauterine balloon tamponade, vertical compression sutures were placed in the uterine isthmus. However, severe uterine atony and atonic bleeding from the uterine corpus persisted; thus, a second balloon was inserted into the uterine corpus. Hemostasis was accomplished with a combination of isthmus vertical compression sutures and double balloons which is a less-invasive approach than existing compression techniques. No complications related to these procedures were observed. This step-by-step minimally invasive hemostatic technique has the potential to control PPH with less complications, especially in immunocompromised patients.

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“…There were 12 reports (7 English and 5 Japanese articles), and 14 patients were identified, including our patient. Interestingly, all patients were from Asian counties (Japan [ 3 , 4 , 7 ]), South Korea [ 2 , 6 ] Vietnam [ 5 ]. Here, we reviewed eight patients from 6 English articles, including our patients with SLE during pregnancy with uterine wall thinning and PAS (Table 1 ).…”

Section: Discussionmentioning

confidence: 99%

Diffuse myometrium thinning and placenta accreta spectrum in a patient with systemic lupus erythematosus (SLE): a case report and review of the literature

Mitoma

Hayata

Yokohata

et al. 2022

BMC Pregnancy Childbirth

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Background Cases of uterine wall thinning and placental abnormalities complicated with systemic lupus erythematosus (SLE) during pregnancy have been reported in Asian countries for ten years. Long-term steroid use can cause muscle degeneration, but the mechanism of myometrium thinning was not known. Through the review of published articles, this report is the first review of cases to discuss the pathogenesis and clinical features of thinned myometrium and placenta accreta spectrum (PAS) in pregnant patients with SLE. Case presentation A twenty-nine-year-old primigravida with a history of lupus enteritis and paralytic ileus had a natural conception after less than two years of steroid treatment. An ultrasonographic study showed a thin uterine wall with a widespread thick placenta on the entire surface of the uterine cavity in the third trimester. At the 39th gestational week, she underwent a cesarean section due to the failure of the uterus to contract, even though the injection of oxytocin. There were several engorged vessels on the surface of the anterior uterine wall at the time of laparotomy. We decided to perform a hysterectomy because diffuse PAS replaced her uterus. Conclusion A review of reported cases and our case shows an unusual complication of SLE that might be related to the particular condition of the estrogen-mediated immune system. Clinicians should always pay attention to the possibility of uterine wall thinning as uterine atony and the structural abnormality of the placenta for SLE patients with the unscarred uterus.

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Case report of a pregnant patient with systemic lupus erythematosus with uterine atony and very thin myometrium with uterine fibrosis

Abstract: A pregnant patient with systemic lupus erythematosus experienced hypertension and underwent cesarean delivery. They experienced uterine atony and a very thin myometrium with uterine fibrosis.

Cited by 5 publications

References 4 publications

Pregnancy with Mixed Connective Tissue Disease: exploration of factors influencing live birth outcomes

Pregnancy with Mixed Connective Tissue Disease: exploration of factors influencing live birth outcomes

“Step-by-Step” Minimally Invasive Hemostatic Technique Using Intrauterine Double-Balloon Tamponade Combined with Uterine Isthmus Vertical Compression Suture for the Control of Placenta Accreta and Severe Atonic Hemorrhage during a Cesarean Section

Diffuse myometrium thinning and placenta accreta spectrum in a patient with systemic lupus erythematosus (SLE): a case report and review of the literature

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