• The features of pregnancy and delivery in pregnant women with systemic lupus erythematosus and antiphospholipid syndrome 

The features of pregnancy and delivery in pregnant women with systemic lupus erythematosus and antiphospholipid syndrome 

PERINATOLOGIYA I PEDIATRIYA. 2016.2(66):9-13; doi 10.15574/PP.2016.66.9 

The features of pregnancy and delivery in pregnant women with systemic lupus erythematosus and antiphospholipid syndrome 

Davydova Yu., Shevchuk E., Limanskaya A., Garmish E., Ogorodnyk A. A.

SI «Institute of Pediatrics, Obstetrics and Gynecology NAMS Ukraine», Kyiv

SE «National Centre «Institute of Cardiology. M.D. Strazhesko», Kyiv, Ukraine 

Purpose: Systemic lupus erythematosus (SLE) is an autoimmune disease that primarily affects young women. Pregnancy in women with SLE is regarded as a high risk of obstetric and perinatal complications, as well as at high risk of maternal and perinatal morbidity and mortality. 

The aim — to analyze the features of pregnancy and childbirth in women with systemic lupus erythematosus and antiphospholipid syndrome. 

Materials and methods. The prospective study included 96 pregnant women with systemic lupus erythematosus (SLE) and APF, among them only 62 SLE (group 1) and 34 with SLE and APS (group 2). Review during the analysis of pregnancy, childbirth postpartum period in these groups of pregnant women. A control group comprised 36 somatically healthy pregnant women with physiological pregnancy. 

Results. SLE and APS women are a group at high risk for the development of obstetric complications that caused of abnormal placentation (hypertensive complications, premature birth). The frequency was significantly higher in the SLE group. Substantiated and implemented a system of improved perinatal care for pregnant women this groups include a unified approach to the diagnosis of SLE and SLE activity assessment. Use a personalized approach based on the data on the age debut SLE, duration at the time of the onset of the pregnancy, treatment, SLEDAI score at the time of the taking under observation, SLEDAI score in the first and second half of pregnancy. In the group of pregnant women with SLE and APS risks of thromboembolic disorders is very high and require adequate thromboprophylaxis. However, it is necessary when using LMWHs in these patients to carry out careful monitoring of the platelet count, as in autoimmune processes, which include SLE and APS, and inadequate monitoring of SLE activity likely thrombocytopenia. It should be noted the high incidence of complications of pregnancy and labor in a previous pregnancy in multiparous both groups. In patients 1 and 2 groups, there were no cases of antenatal and intrapartum fetal death, however, 12 (19.3%) children in group 1 and 8 (26.7%) in the second required a long stay in the intensive care unit newborns with subsequent transfer to the stage postintensivnoy rehabilitation. 

Conclusions. There is high frequency of obstetric and perinatal complications of pregnancy and childbirth with SLE women occurs. Particularly noteworthy are pregnant with SLE and APS who have significantly more marked IUGR, premature detachment of normally situated placenta, the need for early delivery (p<0.001). Prenatal care in these patients it is advisable to carry out as part of a multidisciplinary team. In the group of pregnant women with SLE and APS using quantitative risk assessment method thromboembolic complications revealed an extremely high rate risk, which makes it possible, using data from evidence-based medicine, to conduct effective thromboprophylaxis drug enoxaparin, having an appropriate level of safety (according to FDA guidelines) and high efficiency, proven in many randomized clinical trials. 

Key words: pregnancy, SLE, APS, perinatal outcomes, multidisciplinary team, thromboembolism, thromboprophylaxis. 


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