SLE

Question 1

Pregnancy effect on SLE

Answer 1

risk of lupus flare

deterioration in renal function

Question 2

SLE effect on pregnancy

Answer 2

PET
HTN
DVT
IUGR
PTB
SB/miscarriage
neonatal lupus

Question 3

Pre-conception counselling should include

Answer 3

severity assessment
contraindication
prognosis
adjust medication
refer
routine antenatal care

Question 4

SLE labs

Answer 4

FBC, UE, LFTs
anti cardiolipin, lupus anticoagulant, b2 glycoprotein
dsDna, complement
ANA, anti-sm
anti-Ro, anti-La
Consider cardio and resp investigations

Question 5

SLE flare

Answer 5

rising dsdna

dropping complement

Question 6

Managment SLE antepartum

Answer 6

monthly testing of disease activity
consider TOP if severe disease
ECHO if ro or la
several ogtts if on steroid
monthly growth scans

Question 7

Management SLE intrapartum

Answer 7

aim vaginal delivery
stress steroid
maintain fluid balance
avoid ergometrine if bp up

Question 8

Management SLE PP

Answer 8

Anticipate PPH
Debrief
Advice future pregnancies
baby needs workup/assessment neonatal lupus +/- pacemaker if congenital heart block

Question 9

Effect of pregnancy of RA

Answer 9

50% have improvement of symptoms
25% significant disability
90% have a postpartum flare

Question 10

Effect of RA on pregnancy

Answer 10

Risk of IUGR and PTL
Infection if on immunosuppression
Anaemia

Question 11

Alternative meds to MTX

Answer 11

o AZA, HCQ, Sulfasalazine
o Biological agents can also be used, but it is recommended that they are discontinued in the third trimester to reduce the amount of medication being present in the neonatal circulation at birth (most discontinued prior to 32 weeks)