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systemiclupuserythematosusandpregnancy anoverview dr anupamakumarconsultantrheumatologistsagarhospital bangalore biologicalprerogativeofeverywomanpregnancyinlupusisnotcontraindicatedmanylupuspatientsdeliverhealthybabiesmanyfamiliesatleastwantonechildfertilityisnotaffectedinpatientswithlupus introduction rashandpatchyhairlossinsle sleisthemostcommonautoimmunemultisystemicdiseasetoaffectwomeninchild bearingyearsprognosisforbothmotherandbabyhaveimportantimplicationsduringpregnancymarriage pregnancyandchildbirthareburningissuesformostpatients sleoverview sle amultisystemicdisease characterizedbyproductionofantibodiestocellnucleuscalledanaswhoisaffected 90 areyoungwomen90 ofthemarein20to40yearsagegroupmorepatientsplanforpregnancybecauseofimprovedprognosis sleoverview pregnancyoutcomesaregoodwhenlupusisinremissionideallylupusshouldbeinactiveforsixmonthsseriousdiseasesuchasactivelupusnephritis myocarditis seizuresisacontra indicationteratogenicdrugslikecyclophosphamide methotrexateshouldbestoppedsixmonthsbeforeconception pregnancycounseling lupuspatientsforpregnancycounselingknownlupuscasescomingforantenatalcareundiagnosedormisdiagnosedlupusinpregnancyasymptomaticpregnantpatientswhohavehistoryofneonatallupusorconcernedantibodies differentpresentations fatigueandfeversarthritisorarthralgiasmalarrashserositisraynaud sphenomenonproteinuriavasculitisleukopeniathrombocytopeniaseizures diagnosis signsandsymptoms malarrashinsle facialrashinsle vasculiticlesionsonhand completebloodcountantinuclearantibodiesbyiforhep2antidoublestrandeddnaantibodiesantiroandantilaantibodiescomplementstudies c3andc4urineanalysisrenalfunctiontestslupusanticoagulantandanticardiolipinantibodies investigations mildriskcases milddisease thosewhoareinremission onnomedicationexceptmildoneshighriskcases severeactivedisease majororganinvolvement thosewithantirooraplantibodiesmoderateriskcases majorityareinthisgroup riskstratification h opreviouspregnancywithcomplicationunderlyingkidney heartorlungdiseaseactivephaseofthediseasepresenceofantiroandantilaantibodiesahistoryofpreviousthromboticeventaplaadditionalfactorslikematernalage 40yearsandpregnancywithtwinsortriplets whatmakesapregnancyhighriskinlupus pregnancyinlupus workingbothways risksoflupustopregnancypregnancylosspretermdeliveryeclampsianeonatallupusduetoroandlaantibodies risksofpregnancytolupuslupusflaresprogressiverenaldiseasematernalthromboembolism miscarriages before20weeks isthemostcommonform averagingabout20 stillbirthsareespeciallyincreasedinlupus 11 neonatallupusanddeathduetochbbecauseofantiroandantilaantibodiesapsrelatedrepeatedpregnancyfailures pregnancyloss increasedlupusactivityatconceptionorduringpregnancyhypertensionhypocomplementaemiarenaldiseasegestationallupus causesofpregnancyloss spontaneousabortionsiugrpretermdeliverypostpartumhaemorrhagematernalvenousthromboembolismneonataldeathduetofetalheartblock adversepregnancyoutcomes highbloodpressureinthemotherafter20weeksofpregnancyoccursin 13 ofwomenw sletx deliverydeliverymaybedelayedinsomewomenwhoarelessthan34weekstogivesteroidsforlungmaturity preeclampsia occursinabout2 ofbabiesborntomotherswithanti ro ssaandoranti la ssbantibodiescausedbypassageoftheantibodiesfromthemother sbloodstreamacrosstheplacentatothedevelopingbabyafterabout20weekssignsofneonatallupusincludesred raisedrashonthescalpandaroundtheeyesthatresolvesby6 8months becausetheantibodiesclearthebloodstream slecomplicationsinbabies completeheartblockandlearningdisabilitiesriskofneonatallupusinsubsequentpregnancyis17 neonatallupus fetalbradycardiashouldbeinvestigatedlookingformaternalantiroantibodiesasmothersmaybeasymptomaticormaydeveloplupuslaterallsuspectedneonatesshouldhaveanecgaschbrecquirespermanentpacingsubsequentpregnancieshavemoreriskofneonatallupus managementofneonatallupus neonatallupus lupusflaresareseeninalltrimestersinmildtomoderatelupus 40 shownochange 40 flareand20 improveflaresaremorecommonwhendiseaseisactiveatconceptionrenalflaresaremostfearedpostpartumflaresarecommonasbeneficialeffectofsteroidproducedbyplacentawearsoffthepatternofthediseasesactivityisusuallyrepeatedinsubsequentpregnancies effectsofpregnancyonlupus musculoskeletalandcutaneousflaresarecommonandeasiertomanagebyincreasingthedoseofprednisoloneivmethylprednisolonemayberequiredforsevereflaresuseorcontinuationofazathioprineisallowedhcqnottobediscontinuedasitisseentocauseflares treatmentofflaresinpregnancy low buthigherthangeneralpopulationlupusrelateddeathsareduetohellpsyndromethromboembolismassociatedwithapspulmonaryhypertensioninfectionfollowingseverelupusflare theriskofmaternaldeath chloasmaormalarrashproteinuriaofpre eclampsiaorworseninglupusnephritisthrombocytopeniainpregnancy hellp orthatoflupusexacerbationoedemaandfluidaccumulationinjointsinlatepregnancyorarthritisofsle differentialdiagnosis prenatalcounselingfrequentantenatalcheckupmonitoringofdiseaseactivity cbc monthlyurineanalysis monthlycomplementsfetalsurveillancebyfrequentultrasoundpatientsmayneedanticoagulationcombinedcare rheumatologist obstretitianandnephrolog
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