Case Series Involving Obstetrics Experiences and Outcomes in Connective Tissue Disease Patients in UKMMC

Abstract

1. Abstract 1.1. Background and Aims: Connective tissue diseases (CTD) such as Systemic Lupus Erythematosus (SLE), Rheumatoid Arthritis (RA), Antiphospholipid Syndrome (APS) and others are likely to be worsening during pregnancy. There are poor pregnancy performances because of the abnormal immune system activity. The aim of the study was to observe the obstetrics experiences and the outcomes. 1.2. Materials and Methods: A retrospective study was done and a total of 58 cases of pregnancy were taken from year 2010-2015 in Universiti Kebangsaan Malaysia Medical Centre (UKMMC). Patients were selected from a list of pregnant women admitted to Patient Admission Centre (PAC) UKMMC diagnosed with CTD and the data was collected from their medical records. 1.3. Results: Fifty-eight pregnancies were observed in 44 women where there were fifty pregnancies (86%) with SLE, 4 (7%) pregnancies with RA and 4 (7%) pregnancies with APS. There were 39 (67.2%) pure CTD patients and 19 (32.8%) CTD patients with comorbidities. There were 6 (9.5%) pregnancies in active group and 52 (82.5%) pregnancies in remission group. Among the 58 pregnancies, there were 33 (57%) birth with no complication, 26 (27%) fetal loss (miscarriage, intrauterine death), 8 (14%) premature babies and 1(2%) neonatal death. Maternal complications were affected by comorbidities (p=0.007). Fetal outcomes were affected by anti-double stranded DNA (p=0.05). Disease activity was affected by pregnancy as the serology tests pre-pregnancy and during pregnancy showed significant association in Complement 3 (p=0.021), Complement 4 (p=0.016) and Urine Protein Creatinine Index (p=0.001). 1.4. Conclusion: This study showed there is a significant association between pregnancy outcomes with antids DNA and comorbidities. There is significant association between pregnancy and Connective Tissue Disease Activity.