[Pregnancy complicated with autoimmune diseases].
Autoimmune disorders such as SLE and ITP occur more commonly in young women and are the most common complications in pregnancy. There is considerable controversy concerning the risk to the mother and fetus, and the optimal prepartum management for minimizing that risk. 1. SLE is an autoimmune disorder in which IgG antibodies such as anti dsDNA-IgG, anticardiolipin IgG, and anti SS-A/Ro IgG are produced. Lupus nephropathy accompanied by diminished serum complement (CH50) and a rise in antibodies against dsDNA is a frequent clinical problem during pregnancy, which represents the adverse effect of hypertension or superimposed toxemia and causes fetal death or intrauterine fetal growth retardation. Habitual abortion or fetal death is common in a case with high anticardiolipin IgG titre. Anti SS-A antibodies are often found in the infants of antibody-positive mothers, and the deposition of antibodies in the perinodal region cause congenital heart block. IgG or immune complexes crossing the placenta directly injures the cardiac conduction system. In these cases which have high titre crossing the placenta directly injuries the cardiac conduction system. In these cases which have high titre of autoimmune antibodies, corticosteroid therapy should be started. 2. Management of ITP in pregnancy involves the consideration of three issues: 1) treatment of maternal thrombocytopenia, 2) prediction of fetal thrombocytopenia, 3) obstetrical management. ITP increases the risk for postpartum bleeding of sufficient severity to require blood transfusion. In most of these cases, maternal platelet counts are found to be less than 30,000/mm3. Women who have symptomatic severe steroid-unresponsive ITP may benefit from intravenous IgG(IvIgG) given as elective treatment.(ABSTRACT TRUNCATED AT 250 WORDS)
Terao
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Department of Obstetrics and Gynecology, Hamamatsu University School of Medicine.
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D001323:Autoantibodies / Q000378:metabolism; D001327:Autoimmune Diseases / Q000276:immunology / Q000628:therapy*; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000627:therapeutic use; D007231:Infant, Newborn; D008180:Lupus Erythematosus, Systemic / Q000188:drug therapy / Q000276:immunology; D007744:Obstetric Labor Complications / Q000517:prevention & control; D011247:Pregnancy; D011248:Pregnancy Complications / Q000276:immunology / Q000628:therapy*; D011295:Prenatal Care / Q000379:methods; D011696:Purpura, Thrombocytopenic / Q000276:immunology / Q000628:therapy
D000305:Adrenal Cortex Hormones; D001323:Autoantibodies; D007074:Immunoglobulin G