There are reports that maternal treatment with hydroxychlo roquine (Plaquenil) is associated with a lower incidence of fetal heart block (Izmirly, 2012). Research in this area is ongoing.
The survival rate for women with SLE is 95 percent at 5 years, 90 percent at 10 years, and 78 percent at 20 years (Hahn, 2015). In general, women with lupus and chronic vascular or renal disease may limit family size because of morbidity associated with the disease and greater risks for adverse perinatal outcomes. For contraception, combination oral contraceptives did not increase the incidence oflupus lares in two large multicenter trials (Petri, 2005; Sanchez-Guerrero, 2005). Progestinonly implants and injections provide efective contraception with no known efects on lupus lares (Sammaritano, 2014). Concerns that intrauterine device (IUD) use and immunosuppressive therapy lead to greater infection rates in these patients are not evidenced-based. Notably, comorbid antiphospholipid antibodies are a contraindication to hormonal methods. Tubal sterilization may be advantageous and is performed with greatest safety postpartum or whenever SLE is quiescent.
his syndrome is an autoantibody-mediated acquired thrombophilia with recurrent thrombosis or pregnancy morbidity as part of its clinical constellation (Moutsopoulos, 2015). Speciically, antiphospholipid syndrome (APS) is diagnosed in women with persistently positive serum tests for antiphospholipid antibodies andwith arterial and/or venous thromboses or obstetrical morbidity. Antibodies include lupus anticoagulant, anti cardiolipin antibody, and anti-32 glycoprotein-I antibody.
Phospholipids are the main lipid constituents of cell and organelle membranes. There are proteins in plasma that associate noncovalently with these phospholipids. Antiphospholipid antibodies are directed against these phospholipids or phospholipid-binding proteins (Giannakopoulos, 2013; Tsokos, 201r1). his antibody group may be ofIgG, IgM, and IgA classes, alone or in combination. Antiphospholipid antibodies are most common with SLE, other connective tissue disorders, and APS. However, a small proportion of otherwise normal women and men have low levels of these antibodies.
The stimulus for autoantibody production is unclear, but it possibly is due to a preceding infection. he pathophysiology encountered is mediated by one or more of the following: (1) activation of various procoagulants, (2) inactivation of natural anticoagulants, (3) complement activation, and (4) inhibition of syncytiotrophoblast diferentiation (Tsokos, 2011). Clinically, these actions lead to arterial or venous thromboses or to pregnancy morbidity. Virtually every organ system may be afected.
Central nervous system involvement is one of the most prominent clinical manifestations. In addition to cerebrovascular arterial and venous thrombotic events, there may be psychiatric features and even multiple sclerosis (Binder, 2010).
Renovascular involvement may lead to renal failure that can be diicult to diferentiate from lupus nephritis (D'Cruz, 2009).