전신성 홍반성 루푸스를 동반한 임산부 94예의 임신 경과 및 산과적 고찰
Clinical course and obstetrical outcomes of 94 pregnancies in Korean patients with systemic lupus erythematosus (SLE)
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Objective: The purpose of this study was to assess the maternal and fetal outcomes in pregnant women with systemic lupus erythematosus (SLE) and to evaluate clinical and laboratory markers for preterm birth and lupus flares. Methods: 94 pregnancies of 60 patients were retrospectively evaluated from Jan 1997 to Sep 2004. We used clinical and laboratory data from the medical records and statistics analysis by Chi-square test, using SPSS 15.0 V. Results: Pregnancy resulted in 74 (78.7%) live births, 11 (11.7%) spontaneous abortions, 2 (2.1%) therapeutic abortion, and 4 (4.2%) stillbirths. Thirty-seven cases (47.4%) were delivered by cesarean section. Obstetric complications included 17.9% of preterm births, 26.9% of preeclampsia, and 20.5% of IUGR. There were 31 (39.7%) uncomplicated cases among the pregnancies over 20 gestational weeks. There were 12 of transient neonatal lupus, 2 of neonatal death due to prematurity, and 51 of normal births. Low C4, myocarditis, pleural effusion prior to pregnancy, activity at conception, antiphospholipid antibody syndrome were significantly associated with preterm birth. The maternal long-term effect of pregnancy was poor, because 44.7% were in deterioration of cardiovascular, hematologic or renal function after delivery. Lupus nephritis, proteinuria, hematuria, and activity at conception were significantly associated with lupus flare during pregnancy. Conclusion: Pregnant women with active SLE at conception should be intensively monitored with maternal and fetal surveillance. It is essential to control disease activity during pregnancy. However, adequate pregnancy follow-up and delivery care by multidisciplinary effort with experience in management of patients with SLE resulted in a better outcome of lupus pregnancy.
Abstract
Objective: The purpose of this study was to assess the maternal and fetal outcomes in pregnant women with systemic lupus erythematosus (SLE) and to evaluate clinical and laboratory markers for preterm birth and lupus flares. Methods: 94 pregnancies of 60 patients were retrospectively evaluated from Jan 1997 to Sep 2004. We used clinical and laboratory data from the medical records and statistics analysis by Chi-square test, using SPSS 15.0 V. Results: Pregnancy resulted in 74 (78.7%) live births, 11 (11.7%) spontaneous abortions, 2 (2.1%) therapeutic abortion, and 4 (4.2%) stillbirths. Thirty-seven cases (47.4%) were delivered by cesarean section. Obstetric complications included 17.9% of preterm births, 26.9% of preeclampsia, and 20.5% of IUGR. There were 31 (39.7%) uncomplicated cases among the pregnancies over 20 gestational weeks. There were 12 of transient neonatal lupus, 2 of neonatal death due to prematurity, and 51 of normal births. Low C4, myocarditis, pleural effusion prior to pregnancy, activity at conception, antiphospholipid antibody syndrome were significantly associated with preterm birth. The maternal long-term effect of pregnancy was poor, because 44.7% were in deterioration of cardiovascular, hematologic or renal function after delivery. Lupus nephritis, proteinuria, hematuria, and activity at conception were significantly associated with lupus flare during pregnancy. Conclusion: Pregnant women with active SLE at conception should be intensively monitored with maternal and fetal surveillance. It is essential to control disease activity during pregnancy. However, adequate pregnancy follow-up and delivery care by multidisciplinary effort with experience in management of patients with SLE resulted in a better outcome of lupus pregnancy.
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