Challenging cases in rheumatic pregnancies. (18th August 2018)

• Record Type: Journal Article
• Authors: Edens, Cuoghi; Rodrigues, Bruna Costa; Lacerda, Marcela Ignacchiti; Dos Santos, Flavia Cunha; De Jesús, Guilherme R; De Jesús, Nilson Ramires; Levy, Roger A; Leatherwood, Cianna; Mandel, Jess; Bermas, Bonnie
• Is Part Of: Rheumatology. Volume 57(2018)Supplement 5
• Page Start: v18
• Page End: v25
• Publication Date: 2018-08-18
• Subjects: anti-phospholipid syndrome -- portal vein thrombosis -- portal hypertension -- pregnancy -- pulmonary arterial hypertension -- scleroderma -- stillbirth -- systemic lupus erythematosus; Rheumatism -- Periodicals; Rheumatology -- Periodicals; 616.723005
• DOI: 10.1093/rheumatology/key172
• Languages: English
• ISSNs: 1462-0324

Abstract

Abstract: This article describes three complicated cases in rheumatology and pregnancy. The first case elucidates the challenges in treating SLE in conjunction with pulmonary arterial hypertension, while the second case features an SLE-affected pregnancy with development of portal hypertension secondary to portal vein thrombosis related to APS. The third case is a pregnant woman with stable SLE who developed thrombotic microangiopathy caused by atypical haemolytic uraemic syndrome, and failed to improve despite multiple measures including biopsy and elective preterm delivery. There are grave and unique challenges for women with autoimmune disease, but adverse outcomes can sometimes be avoided with careful and multidisciplinary medical management. Pre-conception counselling with regard to medications and disease treatment should also include discussion of the advisability of pregnancy, which may be difficult for a patient, but present the best course for optimizing health outcomes.