Embarazo asociado con lupus eritematoso sistémico. Tolerancia immune en el embarazo y su deficiencia en lupus eritematoso sistémico. Un dilemma inmunológico
Pregnancy Associated with Systemic Lupus Erythematosus: Immune Tolerance in Pregnancy and Its Deficiency in Systemic Lupus Erythematosus-An Immunological Dilemma.
J Immunol Res. 2015;2015:241547. doi: 10.1155/2015/241547. Epub 2015 May 18.
Abstract
Pregnancy is a physiological condition that requires immune tolerance to the product of conception. Systemic lupus erythematosus (SLE) is a disease with well-represented immune mechanisms that disturb immune tolerance. The association of pregnancy with systemic lupus erythematosus creates a particular immune environment in which the immune tolerance specific of pregnancy is required to coexist with alterations of the immune system caused by SLE. The main role is played by T regulatory (Treg) cells, which attempt to regulate and adapt the immune system of the mother to the new conditions of pregnancy. Other components of the immune system also participate to maintain maternal-fetal immune tolerance. If the immune system of pregnant women with SLE is not able to maintain maternal immune tolerance to the fetus, pregnancy complications (miscarriage, fetal hypotrophy, and preterm birth) or maternal complications (preeclampsia or activation of SLE, especially in conditions of lupus nephritis) may occur. In certain situations this can be responsible for neonatal lupus. At the same time, it must be noted that during pregnancy, the immune system is able to achieve immune tolerance while maintaining the anti-infectious immune capacity of the mother. Immunological monitoring of pregnancyduring SLE, as well as of the mother's disease, is required. It is important to understand immune tolerance to grafts in transplant pathology.
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Cesárea en un caso de lupus eritematoso sistémico
Caesarean section in a case of systemic lupus erythematosus.
Abstract
Systemic lupus erythematosus (SLE) is an autoimmune disease most frequently found in women of child bearing age and may co-exist with pregnancy. Disease exacerbation, increased foetal loss, neonatal lupus and an increased incidence of pre-eclampsia are the major challenges. Its multisystem involvement and therapeutic interventions like anticoagulants, steroids and immunosuppressive agents pose a high risk for both surgery and anaesthesia. We describe successful management of an antinuclear antibody (ANA) positive parturient with bad obstetric history who underwent elective caesarean section under spinal anaesthesia.
KEYWORDS: Autoimmune; LSCS; pregnancy; systemic lupus erythematosus
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Lupus eritematoso sistémico en la paciente gestante. Implicaciones anestésicas
E.M. Pastor Tomás, J. Guillén Antón, A. Vaquerizo Gareta, P. Lirola Grajales, R. Martínez García y J. Cuartero Lobera
Rev. Esp. Anestesiol. Reanim. 2001; 48: 141-145
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Lupus y embarazo. Mitos y evidencias
Mary-Carmen Amigo Castañeda
An Med Asoc Med Hosp ABC 1999; 44 (4): 183-191
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Enfermedad reumatológica y embarazo
Carlos-Enrique Toro Gutiérrez, Mario Andrés Quintana Duque, María Fernanda Escobar, Carlos Alberto Cañas Dávila, Antonio Iglesias Gamarra, José Félix Restrepo
Rev.Colomb.Reumatol. vol.14 no.1 Bogotá Jan./Mar. 2007
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Lupus eritematoso sistémico en obstetricia. Implicaciones para el anestesiólogo
Systemic lupus erythematosus and the obstetrical patient--implications for the anaesthetist.
Abstract
Systemic lupus erythematosus (SLE) is a multisystem, chronic inflammatory disease characterized by autoantibody production. The disease is most frequently found in women of childbearing age and therefore may co-exist with pregnancy. The clinical manifestations of the disease are variable and depend on the severity of damage to organ systems such as musculoskeletal, renal, haematological, neurological, cardiac, and respiratory. Many patients require drugs such as aspirin or prednisone. The pregnant patient may experience exacerbations of the disease, neonatal loss, and obstetrical complications such as pre-eclampsia. Patients with the Lupus Anticoagulant are at risk for an abnormal perinatal course. The anaesthetic management will depend on the patient's clinical status and the well-being of the fetus. The patient should be examined to determine the extent of end organ damage, current medications, and the health of the fetus. Laboratory investigations such as a coagulation screen and tests of renal function should be performed before anaesthetic intervention if time permits. A multidisciplinary approach to care of the patient and resources to manage complications are essential to optimize the outcome for both mother and newborn.
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