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

Three women with antiphospholipid antibodies and a postpartum syndrome of pleuropulmonary disease, fever, and cardiac manifestations are presented. Each patient had either lupus anticoagulant or anticardiolipin antibodies or both, but did not have antinuclear antibodies or fulfill the criteria for the diagnosis of systemic lupus erythematosus. No infection or embolus was detected that could explain the pulmonary findings. All three patients had electrocardiographic abnormalities, and one patient developed a cardiomyopathy with extensive immunoglobulin G (IgG), IgM, IgA, and C3 deposition in the myocardium. In addition to the reported association between antiphospholipid antibodies and fetal loss, fetal growth retardation, and preeclampsia, we suggest that patients with antiphospholipid antibodies are at risk for a previously unreported and serious autoimmune postpartum syndrome.
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PMID:A new postpartum syndrome associated with antiphospholipid antibodies. 310 Oct 15

Both maternal isoimmunization and maternal autoimmune disease are associated with fetal death. For isoimmunization the immunologic nature of fetal death (hydrops fetalis) is beyond question, but many of the details are poorly understood. It would be extremely helpful to know what immunologic factors are responsible for the wide variation in the degree of fetal hemolysis. This information would surely lead to improved management of isoimmunized pregnancies and create new and more successful therapies for fetuses at risk for hemolysis. The immunology of autoimmune-associated fetal death is, for the most part, an enigma. For the fetal deaths associated with SLE and the antiphospholipid antibodies, demise appears to be a consequence of uteroplacental vascular damage. But the observable pathology is nonspecific, and the evidence for a direct immunologic mechanism is sparse. The similarity between the uteroplacental vascular lesions found with these autoimmune conditions and those seen in preeclampsia demands more intensive investigation. For the fetal deaths caused by complete congenital heart block associated with maternal autoantibodies, the evidence for a direct immunologic mechanism is now being established. As with isoimmunization, a more complete understanding of autoimmune-associated fetal death will open new avenues of management and therapy.
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PMID:Immunologic disease and fetal death. 311 69

A lupus anticoagulant in pregnancy has almost always been associated with an adverse outcome. In previous reports of successful pregnancy in patients with a lupus anticoagulant, whether treated or untreated, all were complicated by premature delivery, and many were complicated by preeclampsia or placental insufficiency. Four patients with systemic lupus erythematosus and an untreated lupus anticoagulant, had an uncomplicated pregnancy that resulted in a live birth at term. The circulating anticoagulant persisted throughout the pregnancy in three patients, and disappeared spontaneously during pregnancy in the fourth patient. As pregnancy outcome is unpredictable, the best treatment of these patients remains to be determined by controlled studies.
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PMID:Successful pregnancy in systemic lupus erythematosus with an untreated lupus anticoagulant. 313 3

Pre-eclampsia (PE) is a frequent complication of pregnancies in women with systemic lupus erythematosus (SLE). The diagnosis of PE is usually based on clinical features such as hypertension and proteinuria, which could also be features of SLE disease exacerbation. As the management of these conditions is different, tests that could confirm the diagnosis of pre-eclampsia would be helpful. Previous studies have shown that serum urate is elevated in PE, while a fall in serum complement 3 occurs in exacerbation of SLE. In this study we looked at the serum urate and complement 3 levels in a group of SLE patients who were in remission before pregnancy. Patients who developed PE had a significantly higher serum urate level while their serum complement 3 level was similar to patients without PE. Our results suggest that measurement of serum urate together with serum complement 3 would help to diagnose PE, and delivery should not be delayed, especially if intra-uterine growth retardation is suspected, in order to avoid intra-uterine death.
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PMID:Serum urate, complement 3 and pre-eclampsia in patients with systemic lupus erythematosus. 322 45

We describe a patient with no clinical complaints except 5 unexplained spontaneous abortions in whom investigations revealed a positive antinuclear factor, antibodies to native double-stranded DNA, LE cells, a positive Coombs' test, a positive lupus anticoagulant test, and anticardiolipin antibodies. Despite preeclampsia our patient successfully completed her 6th pregnancy after treatment with corticosteroids, subcutaneous heparin, and low dose aspirin throughout the pregnancy. Serial measurements of anticardiolipin antibody showed suppression of anticardiolipin antibody levels with corticosteroids. The response of the lupus anticoagulant was less obvious. No anticardiolipin antibodies were detected in the baby.
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PMID:Subclinical autoimmune disease and recurrent spontaneous abortion. 356 Jan 7

It is often difficult to differentiate between an exacerbation of systemic lupus erythematosus (SLE) and intercurrent pre-eclampsia in a patient with SLE since the manifestations of both entities include proteinuria and hypertension. This study was undertaken to determine wether serum C3 and C4 values can help distinguish SLE activity from pre-eclampsia. In 21 nonpregnant women of child-bearing age, the mean C3 level was 124 +/- 5 mg/dl and the mean C4 was 31 +/- 1 mg/dl. In 24 normal women in the third trimester of pregnancy, the C3 and C4 levels were elevated (165 +/- 4 mg/dl, p less than 0.001 versus nonpregnant control women; 37 +/- 2 mg/dl, p less than 0.01 versus nonpregnant control women, respectively). In 17 women in the third trimester of pregnancy with documented pre-eclampsia, the mean C3 level was 162 +/- 4 mg/dl, no different from that in normal pregnant women (p less than 0.001 versus nonpregnant control women; p = NS versus normal pregnant women), and the mean C4 was 29 +/- 3 mg/dl, lower than that found in normal pregnant women (p less than 0.02 versus normal pregnant women). Antinuclear antibody was absent at titers of less than 1:20 in all of these pre-eclamptic patients. In contrast, pregnant women with SLE has significantly lower C3 (103 +/- 13 mg/dl) and C4 (15.3 +/- 3.6 mg/dl) values during the third trimester of pregnancy than either normal pregnant women (p less than 0.001 for C3 and C4) or women with pre-eclampsia (p less than 0.001 for C3 and p less than 0.004 for C4) during the third trimester of pregnancy. Of the eight women with SLE in whom serial complement values were determined, three had falling C3 or C4 levels, and in each, there was a flare of SLE activity either during or immediately after pregnancy. None of the five patients with a rising C3 concentration had a flare of disease activity; however, pre-eclampsia developed in one of these patients, characterized by hypertension and proteinuria. Thus, measurement of serum C3 and C4 can help differentiate between SLE activity and pre-eclampsia, since both C3 and C4 are significantly lower in women with SLE than women with pre-eclampsia, and serum C3 and C4 concentrations rise during uncomplicated or pre-eclamptic pregnancy in women with SLE.
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PMID:Serum complement values (C3 and C4) to differentiate between systemic lupus activity and pre-eclampsia. 374 78

A retrospective review of maternal mortality in the obstetric unit of Bangkok's Ramathibodi Hospital in 1969-82 was conducted. In this 14-year period, there were 72,872 live births and 26 maternal deaths, yielding a maternal mortality rate of 0.4/1000. Direct obstetric causes accounted for 77% of these deaths. The distribution of the 20 direct obstetric deaths was as follws: septic abortion (10 cases), puerperal infection (3 cases), pre-eclampsia (1 case), eclampsia (2 cases), amniotic fluid embolism (3 cases), and placenta percreta with uterine rupture (1 case). Among the 6 deaths attributable to indirect causes, viral hepatitis was responsible for 3, systemic lupus erythematosus was the cause in 2 cases, and cardiac failure occurred in the final case. The maternal mortality rate was 0.8/1000 amond women 19 years of age and below and 0.6/1000 among women 35 years of age and above compared with 0.2/1000 among those 20-34 years of age. Maternal mortality was 0.6/1000 for cesarean section delivery compared with 0.1 for normal delivery. Ongoing statistical analyses of maternal mortality are urged to serve as the basis for preventive measures.
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PMID:Maternal mortality in Ramathibodi Hospital: a 14-year review. 383 Dec 6

Early reports on SLE were too small in number to determine that pregnancy was contraindicated in patients with renal involvement. Later reports show that patients with lupus nephropathy can have successful pregnancies provided certain preconditions are established. Optimal preconditions include prepregnancy remission of at least 6 months, renal function with serum creatinine 1.5 mg/dl or less or creatinine clearance of 60 ml/min or more or proteinuria of 3 g/24 hr or less. Successful pregnancies have been recorded in some patients with more severe renal impairment. Renal function will remain unchanged in approximately 60% of pregnancies; and although deterioration may occur, it is only severe or permanent in less than 10%. In 26% of patients, mild to severe renal impairment was transient, with recovery to prepregnancy levels of renal function. Proteinuria with good creatinine clearance may not be dangerous. Hypertension or superimposed preeclampsia jeopardizes the outcome. Fetal outcome averaged approximately 70% (range, 41-77%) live births, 17.8% (range, 5.1-40%) spontaneous abortions, 19.7% (range, 3.0-38.5%) prematurity, and 8.2% SGA. Therapeutic abortion is not a modality of treatment of lupus nephropathy. Management of patients with lupus nephropathy is twofold and includes suppression of underlying lupus activity as well as the serial evaluation of chronic renal disease. In chronic lupus nephropathy with inactive SLE maternal and fetal outcome is the same as for pregnant patients with chronic renal disease of other causes. Strict fetal surveillance must be performed to decrease the stillbirth rate. The concomitant increase in prematurity demands the services of a tertiary care neonatal unit. Management necessitates the team approach of the obstetrician, nephrologist, rheumatologist, and neonatologist working in collaboration. The reports which contain large numbers of patients now allow better counseling of these patients who are contemplating pregnancy.
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PMID:Lupus nephropathy and pregnancy. 389 19

We identified eight patients with the lupus anticoagulant (an autoantibody acquired by some patients with systemic lupus erythematosus), by observation of an increased activated partial thromboplastin time and abnormal results on a tissue thromboplastin-inhibition test. The patients had experienced a total of 30 spontaneous abortions and fetal deaths in 31 previous pregnancies (96.8 per cent). During their next pregnancy, the patients were treated with 40 to 50 mg of prednisone per day and 81 mg of aspirin per day. The therapy shortened their activated partial thromboplastin times, produced normal values for tissue thromboplastin inhibition, and reduced the rate of pregnancy loss to 37.5 per cent. However, preeclampsia developed in the five patients who gave birth to live infants, and fetal growth retardation occurred in three cases. The corticosteroid and low-dose aspirin regimen appears to improve perinatal outcome in cases in which the mother has the lupus anticoagulant, but such practices as careful fetal surveillance and preterm delivery when appropriate are also important to successful obstetric management of such cases.
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PMID:Obstetric complications associated with the lupus anticoagulant. 393 54

Placentae from 140 term pregnancies were studied. Seventy-four were from uncomplicated pregnancies in which the neonates were within the normal weight range for their gestational age. The remaining 66 placentae were from pregnancies whose infants were small for gestational age (SGA). In eight cases of this latter group a curettage of placental bed was performed during caesarean section. Maternal arterial vessels with absence of trophoblastic migration were observed in basal decidua and basal plate, and acute atherosis in parietal decidua, basal decidua and basal plate, all of them in cases of the SGA group. Furthermore, chronic vasculitis-like lesions were observed in the parietal decidua of three cases from the SGA group and in two others of the control group. No vascular lesions were found in cases of the control group when an infant's birthweight was above the 25th percentile of the normal ponderal range. Atheromatous-like lesions have been described in placental bed arteries in pre-eclampsia, systemic lupus erythematosus and SGA infants: this type of vasculopathy has also been described in rejection of renal transplants. Moreover, lesions similar to those found in chronic vasculitis were also described in the latter pathological entity. It is suggested that these vasculopathies may represent different steps of the same lesion. On the other hand, they may also be the expression of a maternal immunological attack on placental tissues causing a deficit of placentation, low birthweight being the consequence of this deficit.
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PMID:Maternal vascular lesions in placentae of small-for-gestational-age infants. 402 55


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