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Obstetric outcome in systemic lupus erythematosus
F Lima1, N M Buchanan, M A Khamashta
1Lupus Pregnancy Clinic, St. Thomas' Hospital, London, England.
Seminars in Arthritis and Rheumatism
|December 1, 1995
Summary
Careful management of lupus pregnancies significantly improved live birth rates from 31% to 82%. While prematurity was common, lupus flares during pregnancy did not elevate fetal loss risk, especially with antiphospholipid syndrome.
Area of Science:
- Obstetrics and Gynecology
- Rheumatology
- Maternal-Fetal Medicine
Background:
- Systemic lupus erythematosus (SLE) poses significant risks to fetal and maternal outcomes in pregnancy.
- Previous obstetric history in lupus patients shows suboptimal live birth rates.
Purpose of the Study:
- To investigate the fetal and maternal outcomes of pregnancies in lupus patients.
- To evaluate the effectiveness of a multidisciplinary care protocol for lupus pregnancies.
Main Methods:
- A prospective study involving 108 pregnancies in 90 lupus patients.
- Shared care model involving rheumatologists, obstetricians, and hematologists.
- Treatment of lupus flares with low-dose prednisolone, azathioprine, and hydroxychloroquine.
Main Results:
- Live birth rate increased from 31% to 82% compared to previous obstetric history.
- High incidence of prematurity (43%) observed.
- Secondary antiphospholipid syndrome increased fetal loss risk (P = .006).
- Pregnancy flares (57%) were mostly mild and did not increase fetal loss risk.
Conclusions:
- Multidisciplinary management substantially improved fetal outcomes in lupus pregnancies.
- Careful monitoring and treatment are crucial for successful lupus pregnancy management.
- Antiphospholipid syndrome is a significant risk factor for fetal loss in lupus pregnancies.