Obstetrical outcome of pregnancy in patients with systemic Lupus Erythematosus.: A study of 60 cases
Obstetrical outcome of pregnancy in patients with systemic Lupus Erythematosus.: A study of 60 cases
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DOI：
10.1016/s0301-2115(98)00312-1
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发表时间：
1999-04-01
期刊：
影响因子：
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通讯作者：
Balasch, J
中科院分区：
文献类型：
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作者：
Carmona, F;Font, J;Balasch, J
目的：分析系统性红斑狼疮（SLE）患者的母体疾病病程及妊娠结局。研究设计：在11年的时间里，我们前瞻性地跟踪了巴塞罗那（西班牙）三级保健中心46例SLE患者的60例妊娠。管理方案包括：(1)疾病不活跃时的受孕计划；(2)经常进行内科-产科团队随访；(3)使用序贯超声、多普勒和胎儿超声心动图检查；(4)母体免疫状况系列评价；(5)有抗磷脂抗体的妇女在尝试受孕前1个月及整个妊娠期间服用低剂量阿司匹林。从1985年到1994年，所有狼疮患者在妊娠的最后一个月和产褥期的第一个月使用泼尼松预防；从1995年起，这一制度被抛弃了。结果：患者的平均（sd）年龄为28.6（4.8）岁（范围20至42），以前SLE的平均（sd）持续时间为6.25（4.8）年（范围0至17）。2例（3.3%）在妊娠期间被诊断为SLE， 4例（6.7%）在妊娠期发病；当时有9例患者（15%）正在服用强的松。狼疮肾病患者抗磷脂抗体阳性16例（30.4%），妊娠10例（16.7%）。妊娠早期流产3例（5%），自愿流产4例（6.7%）。其余53例妊娠的产科并发症包括：早产11例（20.8%）；宫内发育迟缓5例（9.4%）；高血压10例（18.9%），其中5例符合子痫前期标准；胎膜早破4例（7.5%）；最后，13名新生儿的出生体重低于2500克。有15例狼疮发作（28.3%），每例患者/月发作率为0.044次。有5例新生儿死亡（围产期死亡率，94%）：1例因完全心脏传导阻滞，3例因极端早产导致的严重透明膜疾病，1例因Leiden突变患者宫内死亡。结论：SLE患者的妊娠不应被视为母亲或婴儿不可接受的高风险情况，只要准确计划受孕，并根据仔细的多学科治疗计划对患者进行管理。1999爱思唯尔科学爱尔兰有限公司版权所有。
Objective: To analyze the course of maternal diseases and the outcome of pregnancy in patients with systemic Lupus Erythematosus (SLE). Study design: During a period of 11 years we prospectively followed 60 pregnancies in 46 SLE patients in a tertiary care center in Barcelona (Spain). The management protocol included: (1) planning of conception when disease was inactive; (2) frequent follow-up visits by an internist-obstetrician team; (3) use of sequential ultrasonographic, Doppler and fetal echocardiographic examinations; (4) serial evaluations of maternal immunological condition; and (5) low dose aspirin from 1 month before attempting conception and throughout pregnancy was added in women with antiphospholipid antibodies. From 1985 until 1994 prednisone prophylaxis was used in all lupus patients during the last month of pregnancy and during the first month of the puerperium; from 1995 onwards this regime was abandoned. Results: The mean (S.D.) age of patients was 28.6 (4.8) years (range 20 to 42) and the mean (S.D.) previous duration of SLE was 6.25 (4.8) years (range 0 to 17). SLE was diagnosed during the pregnancy in two cases (3.3%) and the disease was active at conception in four cases (6.7%); at that time nine patients (15%) were taking prednisone. Antiphospholipid antibodies were positive in 16 patients (30.4%) and there were 10 (16.7%) pregnancies in patients having lupus nephropathy. There were three first-trimester miscarriages (5%) and four (6.7%) voluntary abortions. Obstetric complications in the remaining 53 pregnancies included: preterm delivery, 11 cases (20.8%); intrauterine growth retardation, five cases (9.4%); hypertension, 10 patients (18.9%), five of them fulfilling the criteria of preeclampsia; premature rupture of membranes, four patients (7.5%); finally, 13 neonates had a birthweight lower than 2500 g. There were 15 lupus flares (28.3%), giving a flare rate of 0.044 per patient/month. There were five neonatal deaths (perinatal mortality rate, 94%): one because of complete heart block, three due to severe hyaline membrane disease resulting from extreme prematurity and one intrauterine death in a patient having the Leiden mutation. Conclusion: Pregnancy in patients with SLE should not be regarded as an unacceptable high-risk condition for the mother or her baby provided that conception is accurately planned and patients are managed according to a careful multidisciplinary treatment schedule. (C) 1999 Elsevier Science Ireland Ltd. All rights reserved.