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Query: UMLS:C0024141 (systemic lupus erythematosus)
 44,322 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Both lupus anticoagulant and anticardiolipin antibody are groups of antiphospholipid antibodies associated with high frequency of thrombosis, fetal loss and thrombocytopenia. The hall marks of their identification is the prolongation of phospholipid-dependant coagulation tests. Much is written in literature about the successful management of lupus anticoagulant during pregnancy, via corticosteroid and acetyl salicylic acid (Aspirin) therapy; however, up to now only little has been mentioned about maternal and fetal complications associating lupus anticoagulant and its management. Here we present three cases with significant complications among patients with lupus anticoagulant managed in Sint Augustinus Hospital over the last 3 years. These complications were secondary to antiphospholipid syndrome or to therapy. Maternal complications included gastritis, atrophy of quadriceps muscle, resistant premature contractions and pre-eclampsia. One of our patients developed small lymphocytic lymphoma 1 year after her last labour. Fetal complications included: prematurity, suprarenal insufficiency (temporary) and delayed neuromuscular development found at the 2 year follow-up. As far as we know, some of these complications have never been mentioned in literature.
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PMID:Maternal and fetal complications associating lupus anticoagulant and its management; three case reports. 211 27

A patient with lupus anticoagulant and anticardiolipin antibody developed preeclampsia at 24 weeks' gestation. Therapy with human immunoglobulin (Ig) resulted in stabilization of preeclampsia and suppression of the lupus anticoagulant. Anticardiolipin antibody titers were partially suppressed. Preeclampsia worsened at 32 weeks' gestation, and a healthy infant was delivered. For patients with preeclampsia secondary to lupus anticoagulant before the fetus is viable, human Ig is a potential therapeutic option.
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PMID:Human immunoglobulin therapy for preeclampsia associated with lupus anticoagulant and anticardiolipin antibody. 212 Jun 49

Ten pregnancies in patients with systemic lupus erythematosus were reviewed. Preterm delivery occurred in 4 cases (40%), fetal growth retardation in 2 (20%) and intrauterine death in 2 (20%). Preeclampsia developed in one case, which was the only found maternal complication. The most important factor associated with poor outcome was lack of antenatal care. Most of the SLE-complicated pregnancies can anticipate a favorable outcome if, and only if, there is a well-planned management with close cooperation among the patient, obstetrician, rheumatologist and neonatologist.
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PMID:Pregnancy in patients with systemic lupus erythematosus. 217 72

Lupus pregnancies may be complicated by difficulties in the diagnosis of flare, by complications related to aPL antibody, complications related to neonatal lupus, and by a high frequency of preeclampsia. Lupus pregnancies are often difficult to manage, but most complications can be anticipated and, with care, successfully managed.
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PMID:Pregnancy associated with systemic lupus erythematosus. 218 46

To study the occurrence and significance of pregnancy-associated hypertension and pre-eclampsia in systemic lupus erythematosus (SLE), we studied retrospectively 34 pregnancies in 27 SLE patients in 1981-87. Eleven pregnancies (32%) were hypertensive (group A). The remaining 18 patients during their 23 pregnancies had a normal blood pressure (group B). Previous nephritis was slightly more common in the hypertensive group (54.5% vs. 26.1%, NS). Preeclampsia was present in seven of the pregnancies (21%) and of whom four were superimposed. Flare-ups of the disease were more common in the non-hypertensive group (30.4%) than in group A (9.1%) (NS). Duration of pregnancy was the same in the two groups. Intra-uterine growth retardation was present in 27.3% of the pregnancies in group A and in 13.0% of group B (NS). Fetal loss occurred only in 2 patients of the non-hypertensive group; one patient had exacerbation of SLE and the other (with two stillbirths) high anticardiolipin antibodies. Our data suggest that pregnancy-associated hypertension and pre-eclampsia do not cause increased fetal loss in pregnancies affected by SLE. There seem to be other factors that are more important, such as antiphospholipid antibodies and flare-ups of the disease.
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PMID:Hypertension as a risk factor in pregnancies complicated by systemic lupus erythematosus. 227 Jul 63

Since systemic lupus erythematosus most frequently affects women of childbearing years, the management of patients during pregnancy is an important and common problem facing the clinician. This review concerns the effects of pregnancy on the course of maternal disease and fetal well-being. On the maternal side are the problems of renal disease which may exacerbate and be difficult to differentiate from pre-eclampsia especially when occurring in the third trimester. An active urinary sediment, falling C3 and CH50 and elevated complement split products of the alternative pathway and terminal attack complex may serve as useful parameters of lupus activity. In general, maternal disease is not an imposing threat and prospective studies suggest that the exacerbation rate is not significantly greater in the pregnant lupus patient than in the non-pregnant patient. On the fetal side are the problems of placental insufficiency and in utero attack on developing organs. Maternal antibodies such as those reactive with negatively charged phospholipids are associated with second trimester miscarriages and suggested, but not firmly established, thrombosis of placental vessels. The placental transfer of maternal antibodies against components of the rapidly expanding group of SSA/Ro-SSB/La ribonucleoproteins is strongly implicated in the transient and permanent manifestations of neonatal lupus. Using various techniques for defining the specificity of the antibody response most associated with heart block, the data suggest that mothers whose sera contain antibodies which recognize antigens of SSA/Ro-SSB/La on SDS-immunoblot are at greatest risk. In the absence of antibodies to SSB/La, mothers whose sera contain antibodies reactive only to bovine SSA/Ro by ELISA do not appear to be at high risk. A rational approach to in utero treatment of autoantibody mediated fetal myocarditis includes plasmapheresis and the use of dexamethasone. Finally, the safety of the commonly used medications for the treatment of lupus such as the nonsteroidal anti-inflammatory agents, glucocorticoids and anti-malarials during gestation and breast feeding, is addressed.
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PMID:Systemic lupus erythematosus and the maternal-fetal dyad. 228 64

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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PMID:[Systemic lupus erythematosus and pregnancy. Clinical aspects, serology and management]. 239 Oct 23

Lupus anticoagulant (LAC), an autoantibody, in maternal circulation is responsible for a high incidence of fetal loss. We record 2 cases of recurrent fetal loss in association with LAC. The presence of LAC was diagnosed by prolonged activated partial thromboplastin time (aPTT), but was not correctable by dilution with normal plasma. During their subsequent pregnancies, these two women were treated with prednisolone and a low dose of aspirin (100 mg/day). Normal values of aPTT were achieved in both cases after treatment. Preeclampsia developed in one of the women, and a live premature infant was delivered by cesarean section. However, a successful term pregnancy was achieved in the other case. Corticosteroid and low-dose aspirin appear to improve fetal outcome in cases with LAC.
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PMID:Recurrent fetal loss with circulating lupus anticoagulant: report of 2 cases. 251 8

Antiphospholipid antibodies (APAs) may be identified in the laboratory by using either coagulation studies or solid-phase immunologic assays (ELISA; RIA). These methodologies do not necessarily evaluate the same antibody; consequently, it is appropriate to screen a patient's plasma by utilizing both assays. APAs have been associated with a variety of obstetrical complications including recurrent spontaneous abortion, intrauterine fetal death, early onset preeclampsia, deep vein thrombosis, and postpartum serositis syndrome. The Kaolin Clotting Time appears to be the most sensitive coagulation test for identifying the lupus anticoagulant. However, preliminary studies would suggest the presence of anticardiolipin antibodies as detected by solid-phase assays are more sensitive and predictive of the clinical course. Although there are no prospective trials to analyze treatment of patients with APA, preliminary data suggest the use of prednisone in combination with aspirin significantly improves the probability of delivery of a viable infant. In addition, heparin, intravenous gammaglobulin, and exchange plasmaphoresis have all been tried with varying degrees of success in individual patients in small series.
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PMID:Antiphospholipid antibodies and reproduction. 251 82

To evaluate risk for exacerbation of systemic lupus erythematosus (SLE) during pregnancy, we prospectively evaluated 80 pregnant women with SLE for manifestations of disease activity. Fifty-three of these women were not taking prednisone at the time of conception. Disease activity was scored in 4 ways: global assessment, prednisone therapy, cumulative number of organ systems with abnormalities, and display of abnormalities of each organ system. No patient received prophylactic therapy to prevent disease exacerbation. Thrombocytopenia, proteinuria, and hypocomplementemia were the most common abnormalities and were usually attributable to the pregnancy complications of preeclampsia and anticardiolipin antibody syndrome rather than to SLE. If all possible abnormalities were attributed to SLE, disease exacerbation occurred in less than 25% of all patients; if only SLE-specific abnormalities were counted, disease exacerbation occurred in less than 13%. Worsening of SLE is uncommon in pregnancy, and prophylactic prednisone therapy is unnecessary.
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PMID:Pregnancy does not cause systemic lupus erythematosus to worsen. 232 40


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