Prospective study of pregnancy in systemic lupus erythematosus. Results of a multidisciplinary approach.
Prospective study of pregnancy in systemic lupus erythematosus. Results of a multidisciplinary approach.
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系统性红斑狼疮妊娠的前瞻性研究。
DOI：
10.1097/00006254-198705000-00008
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发表时间：
1986
期刊：
影响因子：
--
通讯作者：
S. Karchmer
中科院分区：
文献类型：
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作者：
G. Mintz;J. Niz;G. Gutierrez;A. Garcia;S. Karchmer
我们的前瞻性研究试图更好地确定妊娠与系统性红斑狼疮 (SLE) 之间的相互关系，以降低孕产妇发病率/死亡率和胎儿流产。我们的方案包括 1974 年至 1983 年间 SLE 患者总数中的所有妊娠。在此期间，75名患者中有102名怀孕； 59.7% 的系统性红斑狼疮患者从非活动性疾病开始，病情恶化，大多数为轻度发作。然而，血液学表现和肾脏疾病需要中等或高剂量的类固醇。没有孕产妇死亡。整个组中有 49% 的早产新生儿，而患有活动性 SLE 的母亲这一比例增加到 59%；整个组中 23% 的新生儿小于胎龄，而患有活动性 SLE 的母亲中这一比例增至 65%。自然流产率为 16%，患有活动性或非活动性疾病的母亲之间没有差异，5 例死产和 1 例新生儿死亡，胎儿总丢失率为 22%（与对照组的 6.7% 相比，p 小于 0.001）。 32例剖宫产手术成功，14例体重低于1.5公斤的新生儿存活。我们的研究表明，对 SLE 患者的母亲进行有计划的风湿病护理，特别是产科和围产期护理，可能会降低孕产妇和胎儿的高发病率/死亡率。
Our prospective study attempted to better define the reciprocal relation between pregnancy and systemic lupus erythematosus (SLE), to reduce maternal morbidity/mortality, and fetal loss. Our protocol included all the pregnancies in our total of patients with SLE between the years 1974-1983. There were 102 pregnancies in 75 patients during this period; SLE was exacerbated in 59.7% that started with inactive disease, most with mild episodes. Hematologic manifestations and renal disease, however, required moderate or high doses of steroids. There were no maternal deaths. There were 49% premature newborns in the entire group and this increased to 59% in mothers with active SLE; 23% of newborns were small for gestational age in the entire group and the rate increased to 65% in mothers with active SLE. There was a 16% spontaneous abortion rate with no difference between mothers with active or inactive disease, 5 stillbirths and one neonatal death, with a total fetal loss of 22% (compared with 6.7% in the control group p less than 0.001). There were 32 cesarean sections with live outcomes and 14 newborn infants with a weight below 1.5 kg survived. Our study shows that in patients with SLE planned rheumatologic care of the mother, with special obstetrical and perinatal attention, may reduce the high maternal and fetal morbidity/mortality.