1988 Volume 40 Issue 6 Pages 711-718
A 26-year-old primiparous woman with systemic lupus erythematosus (SLE) was referred to our clinic at 5 weeks of gestation. She was in an active phase of SLE with malar and discoid rash, leg edema and fever. Prednisolone had been given orally 10mg/day before the pregnancy, and repeated exacerbations and remissions of SLE occurred until the second trimester. At 18 weeks of gestation, a sudden exacerbation of SLE was observed. The dose of prednisolone was increased and she was admitted. From 22 weeks of gestation, she was treated with increased dose of prednisolone and/or betamethasone depending on the activity of SLE. Preeclampsia developed at 22 weeks of gestation, and she was treated with labetalol hydrochloride. At 32 weeks and 2 days of gestation, the amniotic fluid shake test became positive, and a non reactive pattern and recurrent late decelerations were found on non stress FHR monitoring. She was delivered by cesarean section. The 1, 002 grm. male newborn infant had no congenital malformations or respiratory distress syndrome.
SLE is one of the most severe risk factors for both mother and infant. Exacerbation of SLE, nephropathy, and preeclampsia are most common complications. Abortion, stillbirth, feto-placental insufficiency and congenital A-V block of the infant are also observed in this condition.
In our judgement, the most important points in the management of a pregnancy in a woman with active SLE are : (1) to know whether or not the patient is in an active phase, (2) to control the medication and dosage of corticosteroids, according to the degree of exacerbation or remission of SLE, (3) to induce delivery at an appropriate time with sufficient fetal maturity. It is also most important to distinguish between nephropathy of SLE and preeclampsia. Skin lesions, serum complement levels and the erythrocyte sedimentation are useful in the differential diagnosis between the two diseases.
