1. Maria is a Hispanic 30-year-old who has not carried a pregnancy to term. She developed...
1. Maria is a Hispanic 30-year-old who has not carried a pregnancy to term. She developed systemic lupus erythematosus (SLE), or lupus, when she was 25 years old. Maria is a G4P0 and has had three previous fetal demises. She is currently at 32 weeks' gestation and has been asymptomatic during this pregnancy. Maria has been taking a daily dose of prednisone to suppress flare-ups. (Learning Objective 7)
A. What is the management of care for the remainder of Maria’s pregnancy?
B. If Maria’s lupus remains stable, will she require any modifications to standard care for her labor and delivery?
C. How will the management of Maria’s pregnancy change if she develops a flare?
Homework Answers
1, patients with SLE need treatment throughout their pregnancy
with HCQ and low dose steroids. there will be a risk of the fetus
and complex pregnancy. Advice the patient to stop forbidden
medication. most flares occur during pregnancy in the second and
third trimester. close monitoring of vital signs, anti DNA test,
doppler assessment of uterine artery blood flow, repeat USG, check
c3 and c4 level and hemoglobin level, platelet count, serum
creatinine, apl antibody test, IgG,acl test can prevent
maternal and fetus complications. maternal antimalarial therapy
will be safe to make fetus safe and it stop early pregnancy. Avoid
ibuprofen, antihypertensive and paracetamol during 34weeks of
gestation. follow low dose aspirin and dipyridamole as a safe
drug.
2, Women with SLE have a high risk of preterm delivery. women with
stable SLE can expect spontaneous delivery with cephalic or breach
presentation if there are no intrapartum complications.
3, If she develops a flare she needs a cesarian section to avoid
bleeding and risk of infection for the fetus.
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