A Clinical Analysis Of 55 Cases Of Inpatient With Pregnancy And SLE

Objective To explore the clinical characteristics and pregnancy outcomes of pregnancies complicated with systemic lupus erythematosus(SLE), try to evaluate the factors correlated with the maternal fetal outcomes, and preliminary analysis of the situation of such patients clinics.Methods Analyze the clinical characteristics, the relationship between lupus flares and pregnant outcomes, the risk factors for adverse maternal and fetal prognosis, and preliminary analysis of the situation of such patients clinics of 55 cases in pregnant inpatients women with SLE in Suzhou Municipal Hospital and our hospital since January 2010 to august 2014 laboratory test results. SLE diagnostic criteria using the 1997 American College of Rheumatology(ACR) recommended diagnostic criteria for SLE classification. Overall disease activity of SLE was evaluated using the SLE Disease Activity Index(SLEDAI). Active lupus nephritis was defined as proteinuria >500 mg/day(in the absence of preeclampsia or eclampsia), and(or) urinary sediment per high power field> 5 red blood cells and white blood cells or a cell tube, with or without elevated serum creatinine(≥70 mol/L). T-test,χ2 test or Fisher’s exact test and Logistic regression were used for statistical analysis.Results There ages were ranging between 23 to 40 years old, mean age was(28.07± 3.47) years. The age of onset of SLE were ranging between 12 to 33 years old, mean age was(27.8±3.45) years. There were 47(85.5%) multiparous and 8(14.5%) primiparous women. 52 cases diagnosed before pregnancy, duration of 1 to 20 years; Active disease at conception was present in two pregnancies. In three patients, lupus was first diagnosed during pregnancy.Maternal outcomeMaternal lupus flares occurred in 41.8% of pregnancies, mostly in the second trimester(43.5%) and in the third trimester(39.1%). SLE flare during pregnancy and post partum period are usually mild to moderate, with the majority of flare episodes was in the form of lupus nephropathy(91.3%) and hematological(39.1%). The most common obstetric complications were gestational hypertension in 15 pregnancies(27.3%) and preeclampsia in 9 pregnancies(16.4%). Mild renal impairment presented in 12 pregnancies; 2 patients developed acute renal failure. However, no patients developed chronic renal failure. There was no maternal mortality reported. Non-planned pregnancy and previous LN were significantly associated with SLE flares at univariate analysis. However, non-planned pregnancy is the only significant predictors of SLE flares at binary logistic regression analysis. Previous renal lupus disease was found to be a predictor of pre-eclampsia occurrence in univariate analysis.Fetal outcomesOf the 55 pregnancies, 49 resulted in a live birth, four spontaneous miscarriages and 2 in stillbirth. For the 49 live birth, there were 14 preterm babies and 16 fetuses were born with intrauterine growth retardation(IUGR). There are 41 patients during pregnancy line ANA antibody test, 29 cases of anti-SSA antibodies, one patient whose children due to congenital heart block in two days after birth to death. SLE flare, active lupus nephritis and SLEDAI at the pregnancy were significantly associated with fetal loss and adverse fetal outcomes at univariate analysis. However, Non-planned pregnancy at the beginning of pregnancy is the only significant predictors of adverse fetal outcomes at binary logistic regression analysis.TreatmentThe treatment of pregnant inpatients women with SLE included corticosteroids, immunosuppressive, antihypertensive drugs, anticoagulant, plasma treatment. In this study, all patients were taking corticosteroids during pregnancy, mainly included prednisone and methylprednisolone; There are 10 patients before pregnancy use of hydroxychloroquine, three cases of pregnancy disabled; two cases of the use of immunosuppressive therapy after the termination of pregnancy; one patient using the IVIg treatment for 3 days; 15 cases of patients with hypertension to antihypertensive drug therapy, and all cases patients’ blood pressure were up to standard. The types of antihypertensive drugs included CCB, β-blockers, vasodilators and α-blocker, two patients use ARB antihypertensive therapy in the postpartum.Conclusion 1. SLE flare can occur any time during pregnancy, including postpartum period. Fortunately, most are mild to moderate on disease, and with the majority of flare episodes was in the form of lupus nephropathy and hematological.2. Non-planned pregnancy and previous LN were significantly associated with SLE flares. Previous renal lupus disease was found to be a predictor of pre-eclampsia occurrence in univariate analysis.3. It is essential to have a careful preconception planning, choose a appropriate time for conception and monitor carefully during pregnancy.In short, SLE patients once pregnancy guilty of high-risk pregnancy, should be under the obstetrics, rheumatology and Nephrology like common monitoring, select the appropriate time of conception, pregnancy after the close follow-up, closely observe the development of SLE activity of maternal and fetal and aggressive treatment to minimize the pregnancy loss rate and improve mother and child outcome.