Reasons for cesarean and medically indicated deliveries in pregnancies in women with systemic lupus erythematosus. (March 2018)

• Record Type: Journal Article
• Authors: Eudy, A M; Jayasundara, M; Haroun, T; Neil, L; James, A H; Clowse, M E B
• Is Part Of: Lupus. Volume 27:Number 3(2018)
• Page Start: 351
• Page End: 356
• Publication Date: 2018-03
• Subjects: systemic lupus erythematosus -- pregnancy -- preterm birth -- cesarean delivery -- medically indicated delivery -- rheumatoid arthritis; Systemic lupus erythematosus -- Periodicals; 616.772005
• DOI: 10.1177/0961203317720525
• Languages: English
• ISSNs: 0961-2033

Abstract

Objective: To determine reasons for cesarean and medically indicated deliveries in a registry of pregnant women with SLE compared to RA. Methods: Pregnant women with SLE or RA were prospectively followed, and pregnancy outcomes were collected, including whether labor was spontaneous or medically indicated and delivery was vaginal or cesarean. Preterm birth was defined as a birth <37 weeks gestation. Differences in reasons for cesarean delivery and indication of delivery between term and preterm births were determined by Fisher's exact test. Results: Compared to RA pregnancies, SLE pregnancies had modestly higher rates of preterm birth (24% SLE vs 14% RA), pre-eclampsia (15% SLE vs 7% RA), and cesarean delivery (48% SLE vs 30% RA). The majority of preterm births among women with SLE were indicated (70%), most commonly for pre-eclampsia or the health of the infant or mother. The majority of preterm births among women with RA, however, were spontaneous, primarily due to premature rupture of membranes. Conclusion: Pre-eclampsia and maternal SLE activity appear to be the key drivers for the high rate of preterm birth and medically indicated delivery in SLE. This contrasts with RA, where preterm labor is most often due to spontaneous onset of labor.