Systemic lupus erythematosus

doi:10.1136/bmj.39358.519491.AD

BMJ 2007;335:933-936 (3 November), doi:10.1136/bmj.39358.519491.AD

Practice

Pregnancy Plus

Systemic lupus erythematosus

Lucy H Mackillop, obstetric medicine registrar¹, Sarah J Germain, obstetric medicine/diabetes and endocrine registrar², Catherine Nelson-Piercy, consultant obstetric physician³

¹ Queen Charlotte's and Chelsea Hospital, London W12 0HS, ² St Thomas' Hospital, London SE1 7EH , ³ Queen Charlotte's and Chelsea Hospital and St Thomas' Hospital, London

Correspondence to: L H Mackillop lucymackillop@hotmail.com

Systemic lupus erythematosus in pregnancy brings risks for themother, and possible harm to the fetus if the disease is treated.This article discusses the challenges of management

The first 150 words of the full text of this article appear below.

Introduction

Scenario

A 30 year old woman is referred to the obstetric medicine clinic.She is eight weeks pregnant according to the timing of her lastmenstrual period. She has systemic lupus erythematosus (SLE),diagnosed in 1998. The disease has affected predominantly herjoints, but she did have a related nephritis flare in 2000.She has never had a venous or arterial thromboembolus. Her lastSLE flare was three years ago during her last pregnancy, andit was confined to her joints; her baby daughter then (now 3years old) had been delivered normally after induction of labourat 36 weeks' gestation. She had gestational diabetes from 24weeks in her last pregnancy, but an oral glucose tolerance testsix weeks postnatally was normal, confirming true gestationaldiabetes.

Her current medications include azathioprine 125mg once daily, prednisolone 4 mg once daily, hydroxychloroquine200 mg twice daily, and aspirin 75 mg once . . . [Full text of this article]

How common is SLE?

How does pregnancy affect SLE?

How does SLE affect pregnancy?

Box 1 Diagnostic criteria for the antiphospholipid syndrome^w7
Box 2 Factors increasing adverse outcome in pregnancy

How do you manage SLE in pregnancy?

Preconception counselling
Maternal surveillance
Box 3 Baseline investigations
Fetal surveillance
What if the disease flares up in pregnancy?
Box 4 Clinical features common to systemic lupus erythematosusand pregnancy
Analgesics and non-steroidal anti-inflammatory drugs
Immunosuppressants

The case

Conclusion

CiteULike

Complore

Connotea

Del.icio.us Add to Digg

Digg

Technorati What's this?

Inherited thrombophilia and pregnancy associated venous thromboembolism: Wendy Lim, John W Eikelboom, and Jeffrey S Ginsberg
BMJ 2007 334: 1318-1321. [Extract] [Full Text] [PDF]

Systemic lupus erythematosus: David P D'Cruz
BMJ 2006 332: 890-894. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

Ruiz-Irastorza, G, Khamashta, M. (2008). Lupus and pregnancy: ten questions and some answers. Lupus 17: 416-420

Rapid Responses:

Read all Rapid Responses

Treatment of SLE in pregnancy and use of Chloroquine: Lucy E Higgins, et al.
bmj.com, 10 Nov 2007 [Full text]
Treatment of SLE in pregnancy and use of Chloroquine: Lucy H Mackillop, et al.
bmj.com, 13 Nov 2007 [Full text]