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AB0732 Pregnancy outcome in lupus patients with previous adverse outcomes: Experience with protocol based, multidisiplinary care
  1. V. Ravindran1,
  2. K.P. Balakrishnan2,
  3. M. Diwakaran3,
  4. R. Ramakrishnan4
  5. and North Kerala Focus Group on Lupus Pregnancies
  1. 1Department of Rheumatology
  2. 2Department of Cardiology
  3. 3Department of Obstetrics, PVS Hospital, Calicut
  4. 4Department of Obstetrics, Indira Gandhi Hospital, Telicherry, India

Abstract

Background In patients with SLE with previous adverse obstetric outcome(s) the risk of an adverse outcome in subsequent pregnancy rises.

Objectives The primary objective of this study was to assess the impact of a protocol based multidisciplinary care on pregnancy outcome(s) in a prospective cohort of patients with SLE with previous adverse obstetric outcome(s).

Methods Between March 2010 and March 2011 all patients with SLE fulfilling the ACR classification criteria with previous at least one adverse obstetric outcome (maternal; preterm labour, pre ecalampsia or previous medical termination of pregnancy (MTP) in view of SLE flare, foetal; miscarriage, IUGR, preterm birth, low birth weight (LBW), intrauterine death or still birth) desirous of having more children were prospectively enrolled. Briefly the protocol comprised of pre natal counselling, pre-natal drug and disease status review, risk stratification, periodic ante-natal visits for the monitoring of pregnancy (including with obstetric ultrasounds) and disease, 2D echocardiogram at weeks 18 and 32 if Ro/La were positive and post natal disease and drug review and contraception advice. Therapeutic changes were made as necessary at each stage.

Results Fourteen patients (age mean±SD years; 29±3) were enrolled. Previous poor obstetric outcomes were: miscarriage(s) in 6, MTP in 3, preterm labour with IUGR in 2, intrauterine death, still birth and pre ecalapmsia in 1 each. Four patients had secondary APS and 6 had both or either Ro/La positive. Three had lupus nephritis (LN); >6months ago in 2. There were 10 (71%) live births (2 LBW, instrumentation or caesarean section in 3). Three patients had miscarriages (one had ongoing LN). One decided against becoming pregnant after initial counselling. Five patients (35%) had lupus flare (2 mild, 2 moderate and 1 severe based on SLEDAI).

Conclusions Majority of patients in our prospective cohort had acceptable pregnancy outcome. This highlights that for high risk lupus pregnancies a multidisciplinary input with protocol based care offers a superior chance of improved pregnancy outcome.

Disclosure of Interest None Declared

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