A CASE OF SYSTEMIC LUPUS ERYTHEMATOSUS FOR CAESEREAN SECTION

Abstract

Introduction : Systemic Lupus Erythematosus is a chronic multisystem disorder characterized by formation of autoantibodies against nuclear , cytoplasmic and cell membrane antigens . Most common in women of child bearing age group . Disease exacerbation , neonatal lupus , fetal loss and increased incidence of pre-eclampsia are major challenges. Case Report : A 26 year old woman G3P1L0A1D1 with 39 weeks amenorrhea with known history of SLE since 2 years scheduled for elective LSCS . She has bad obstetric history and on medication with Tab.Azathioprine 50mg OD , Tab.Hydroxychloroquine 200mg OD and Tab.Prednisolone 5mg BD. ANA antibodies were found to be positive but antiphospholipid antibodies were negative. Regional anaesthesia preferred over general anaesthesia because of anticipated difcult airway. Subarachnoid block performed using 2ml of 0.5% bupivacaine heavy . Surgery uneventful with minimum blood loss. Discussion ;The peak incidence of SLE occurs between the ages of 15 and 40 years, with an estimated female-to-male incidence of 9:1. It is characterized by autoantibody production and dysfunctional immune system resulting in organ inammation andconsequent damageSLE may be associated with secondary APS which is a multisystem disorder characterized by recurrent systemic arterial and venous thrombosis, recurrent abortion, thrombocytopenia and neurological disorders Musculoskeletal manifestations and mucocutaneous symptoms occur frequently. Anaesthetic management of pregnant patients with SLE depends on the multisystem nature of the disease, the severity of the organ involvement and adverse effects of drugs used in treatment. Conclusion : Anaesthetic management of SLE requires thorough pre anaesthetic evaluation regarding organ involvement , disease activity and drug history . Pharmacological interactions between anaesthetic drugs and immunosuppressants taken into consideration