Placental lesions in systemic lupus erythematosus: A retrospective histopathological study in a tertiary care center

Systemic lupus erythematosus (SLE) is a chronic inflammatory autoimmune disease of unknown etiology. Pregnancy in patients with SLE, however, poses high-risk factors stemming from both maternal (such as lupus flare and preeclampsia) and fetal (including miscarriage and intrauterine fetal death) complications. Although the pathophysiology underlying obstetric mortality and morbidity in SLE is still under investigation, recent studies have suggested that placental dysfunction may significantly contribute. This study investigated the perinatal outcomes of pregnant women with SLE and the histopathological findings in their placentas. Placenta reports and files from 4820 cases were analyzed between January 2016 and January 2024. A retrospective study of 15 placentas from 11 patients with systemic lupus erythematosus was conducted during this period. We examined 15 placentas from 15 pregnancies in 11 patients with confirmed Systemic lupus erythematosus. The mean maternal age was 28.46 years (range: 20-35). The median gestational age at birth was 36 weeks and 4 days (range: 23 weeks and 4 days to 38 weeks and 3 days), and the median placental weight was 545 g (range: 89.2-828 g). A history of previous pregnancy loss, including abortion or stillbirth, was present in 8 of 11 mothers (72.7%). Two pregnancies that did not receive any treatment during pregnancy resulted in stillbirth. Thirteen cases resulted in live birth. Seven patients were preterm. Five cases had retroplacental hematoma. Our examination revealed fetal vascular malperfusion in 1 case and maternal vascular malperfusion in 8 cases. As a result, the macroscopic and microscopic findings of uteroplacental-vascular pathology and pathologic coagulation in the placentas of patients with SLE are noteworthy.