Abstract
Background Indonesia had the serious challenge of highly maternal mortality over last ten years reflecting the real national health problem. There was 305 maternal death/100.000 deliveries, where 3 major possible cause of PE, PPH and infection persisted. Recently the new comer of diseases was standing tightly behind them: lupus on pregnancy. Material & Method This was a retrospective study from medical records.. Fifty-two cases of Lupus from 4592 pregnancy during 4 years (1.13%) have been observed in DR. Soetomo Teaching Hospital (tertiary hospital) Surabaya, Indonesia from January 2013 through December 2016. Results Sixteen cases of lupus were complicated by PE (30.7%), and 37.5% cases with Lupus Nephritis (that mostly showing increased serum creatinin level > 1.4 mg%). The maternal age were 25–34 years old (62.5%) and 62.5% were multigravida. Almost half cases (43.75%) got flare, leading to 25% early termination, while the remaining casesed (75%) were conservatively managed until 34 weeks gestation. Fetal outcome reported as 11 cases (68.75%) having birthweight > 2 kg, with 37.5% asphyxia (low apgar score). Discussion Pregnancy was discouraged in women affected by SLE, due to the disease becoming more aggresive during pregnancy and a poor pregnancy outcome was frequently reported. During pregnancy, the maternal immune system adapts to allow the growth of a semi-allogenic fetus. Significant immunological changes occur including suppression of type-2 helper cells (Th2), but the upregulation of Th1 cytokines in pregnancy may increase the risk for Th1-mediated diseases. The aboved concept was reflected at our study where most cases were sucessfully managed conservative until 34 weeks gestation and majority baby born with birthweight > 2 kg. Conclusions Our results suggest that lupus women are much more likely to develop worsening maternal spesifically preeclampsia and fetal outcomes when they become pregnant.
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