LETTER TO THE EDITOR

Systemic Lupus Erythematosus and Antiphospholipid Antibodies in Pregnancy- A Case Report and Review of the Literature Dear Sir,

In the absence of an established protocol, we propose that management should involve a multidisciplinary group as illustrated by this case. There must be close collaboration between the Obstetrician, Rheumatologist/Nephrologist and Neonatologist from an early stage, especially as correlation between serology and disease activity is not reliable.

In the management of pregnant patients with unusual medical disorder, the multidisciplinary team approach can be useful. We report on a pregnancy complicated by systemic lupus erythematosus (SLE) and its management. A 25 year old woman was known to have SLE for 10 years. Her condition was complicated by hypertension, renal, skin, articular and thromboembolic disease. She had anticardiolipin (ACL) antibodies and was taking atenolol, prednisolone and nifedipine. Her two previous pregnancies ended in 1st trimester abortions. On this occasion she booked at 10 weeks gestation. Because of her previous history management involved joint regular obstetric/ physician review with somewhat less frequent attendance at her rheumatologist. Close monitoring allowed for the quick detection at 24 weeks of a flare up of her SLE, and its successful treatment by increasing steroid dosage. Subsequent deterioration in fetal growth and liquor culminated in caesarean section at 30 weeks gestation after full discussion with the neonatologist. Mother and baby both did well.

References 1. Hopkinson, N. D. Systemic lupus crythcmatosus: epldemiological clues to aetiology. British Journal of ltospltal Medicine, 1991: 45, 291-3. 2. Feinstcin, D. 1. Lupus anticoagulant, thrombosis and fetal loss. Thc New England Journal of Medicinc. 1985: 313, 21. 3. Hadi, H. A., Treadwcll, E. L. Lupus Anticoagulant and Anticardiollpin Antibodies in Pregnancy: A Review II. Diagnosis and Management. Obstetrical and Gynaccological Survey. 1990: 45, 11, 786-91.

Yours sincerely, Dr. Maire Milner Prof. J. Walshe Dr. C. Barry-Kinsella Prof. B. Bresnihan

SLE is not rare, with a prevalence of 20-50/100,000 population 1. The female : male ratio is 9 : 1, and since the peak incidence is in the reproductive years, it is of no little interest to obstetricians. The impact of SLE on pregnancy outcome is adverse, particularly in the presence of antiphospholipid antibodies2. The optimum management of this condition however remains unclear3. High dose steroids, plasmapheresis, platelet inhibitors, heparin, and continuous low dose aspirin have all been proposed, but randomised prospective controlled trials are required and awaited.

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Systemic lupus erythematosus and antiphospholipid antibodies in pregnancy--a case report and review of the literature.

LETTER TO THE EDITOR Systemic Lupus Erythematosus and Antiphospholipid Antibodies in Pregnancy- A Case Report and Review of the Literature Dear Sir,...
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