International Journal of Clinical Obstetrics and Gynaecology
2020, Vol. 4, Issue 2, Part B
Systemic lupus erythematosus: A clinical conundrum in pregnancy
Author(s): Karavadra B and Harlow F
Abstract: Systemic lupus erythematosus (SLE) is a common Rheumatological condition and it is associated with a number of multisystem complications (1). We describe a case report for a 26-year-old pregnant patient who has had long standing systemic lupus erythematosus with a multitude of cardiac, respiratory and obstetric complications secondary to SLE. This is her fourth pregnancy. She has a significant medical history. She has a history of 2 previous caesarean sections, one at 27 weeks for maternal reasons and the other was in January 2016 for a small for gestational age fetus. She has had a mitral valve replacement for severe mitral regurgitation and moderate inflow obstruction secondary to Libman’s Sacks endocarditis related to systemic lupus erythematosus in 2008. She also has Lupus nephritis Class III on biopsy, Creatinine pre-pregnancy was 66 with an eGFR of greater than 90, and during pregnancy Creatinine and Urea rose but returned to 8.7 with a Creatinine of 91 and eGFR of 66. In addition to her complex medical history, this patient also had a complex social history which meant there were issues with the patient engaging in the healthcare system. This is an interesting case for discussion as it raises the issue of multiple-comorbidities of SLE in pregnancy.