[Systemic lupus erythematosus and pregnancy. Clinical aspects, serology and management]

H M Runge, E Röther, J Kerl, A DuBois, L Quaas, H G Hillemanns
Geburtshilfe und Frauenheilkunde 1990, 50 (7): 560-8
Systemic lupus erythematosus (SLE) is an autoimmune disease affecting the connective tissue of the skin and the vascular system. In about 90% of the cases, the first diagnosis is made in women of child-bearing age. We report on 11 pregnancies in 5 patients with SLE. The incidence of SLE was found to be 1:2966 in relation to obstetric cases in our hospital. In one patient, an acute exacerbation of the disease led to preterm delivery in the 31st week of pregnancy. The affected patient died postpartum due to generalised disease and septic complications. In general, perinatal mortality was found to be 25% (excluding early abortion). The number of spontaneous abortions, premature deliveries and small for date babies was elevated in our group of patients, in comparison to the normal group. As a result of our own observations in serological controlled pregnancies and of an extensive review of the literature, we came to the following conclusions: Uncomplicated SLE is no contraindication for pregnancy. However, an SLE nephritis represents a relative or even absolute contraindication, depending on the clinical course. Recent prospective studies permit us to conclude, that a pregnancy will not lead to an aggravation of SLE. On the other hand, SLE can cause complications in pregnancy with a subsequent rise in maternal and foetal morbidity and mortality. Most frequent are preeclampsia, premature labour, foetal maldevelopment and flare-ups of the underlying disease. For monitoring the disease, frequent determinations of complement proteins C3/C4 are helpful. The measurement of the C3 turnover can be used to distinguish between the development of preeclampsia and exacerbation of the disorder.(ABSTRACT TRUNCATED AT 250 WORDS)

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