SLE

Question 1

Autoantibodies possible

Answer 1

ANA
Anti-Ro
Anti-La
Lupus anticoagulant
Anticardiolipin
C3 C4
Anti-dsDNA

Question 2

Effect of pregnancy

Answer 2

Increased likelihood of flare (13-60%)
Increased risk of miscarriage, fetal death, pet, prem, fgr
10% will have permanent renal damage

Question 3

Lupus nephritis

Answer 3

Risk of deterioration higher w higher baseline cr
Risk of flare 30%; higher if not in remission
Higher chance of fetal effects if flare (25-30%)

Question 4

Neonatal complications

Answer 4

CHB 2%

Neonatal cutaneous lupus 5%

Question 5

Lupus effects on pregnancy

Answer 5

Increased risk PET

VTE (especially if anticardiolipin antibody 10% risk)

Question 6

Contraception on lupus patient

Answer 6

POP or IUD

Avoid COCP

Question 7

Pre preg counselling

Answer 7

Severity assessment
Contraindication
Prognosis (mat/fetal)
Adjust meds
Refer to Rheum/renal

Question 8

Severity assessment

Answer 8

Hx/exam
FBC, U/E, LFT, CRP
24hr urine, microscopy
Antibodies
Dsdna, complement - markers for flare (increase dsdna, low complement)
CXR/ECHO if resp/cardiac symptoms
ACA, LA, B2-glycoprotein (APLS) —>need aspirin and clexane

Question 9

Contraindications to preg

Answer 9

Severe lungs, heart, kidney, CNS disease
HF
Hx stroke
Active lupus nephritis
FVC <1L
Pulm hypertension
Past severe pre-eclampsia

Question 10

Meds

Answer 10

Ok: prednisolone, hydroxychloroquine
Caution: azothioprine, cyclosporine
NO: MTX, cyclophosphamide

Question 11

2nd and third trimester manage my

Answer 11

Several GTTs if on steroid
Monthly flare blood tests
Frequent visits for BP and urine

Question 12

Active lupus nephritis different from PET

Answer 12

Active urinary sediment
Rising dsdna antibody levels
Dropping complement
May happen before 20 weeks

Question 13

Labour management

Answer 13

Stress steroid (hydrocortisone Q8H)
Fluid management
Avoid ergometrine