Autoimmune Diseases In Pregnancy

Autoimmune diseases are five times more often among women, the incidence during the reproductive age is highest. Therefore, these disorders are common in pregnant women. Antiphospholipid syndrome (APS) in pregnancy A antiphospholipid syndrome (APS antiphospholipid antibody syndrome (APS)) is an autoimmune disease in which an increased predisposition to thrombosis is and during pregnancy, the risk of miscarriage, pregnancy induced hypertension, pre-eclampsia and intrauterine growth retardation elevated. The antiphospholipid syndrome is caused by autoantibodies against certain phospholipid-binding proteins that protect else from excessive activation of coagulation. Diagnostic measurement of circulating antiphospholipid antibodies. In women with miscarriage history of, or ? 3 cases of fetal death, previous unexplained venous thromboembolism or current venous thromboembolism during pregnancy an antiphospholipid syndrome should be suspected. The diagnosis is made by measuring the circulating antiphospholipid antibodies with positive results in ? 2 occasions at intervals of 12 Wochen.Therapie prophylaxis with anticoagulants and low-dose aspirin women with antiphospholipid syndrome are usually prophylactic anticoagulation with low-dose aspirin during pregnancy and dealt with in the 6 weeks after birth. Immune thrombocytopenic purpura (ITP) in pregnancy mediated by maternal antiplatelet IgG immune thrombocytopenic purpura (ITP, immune thrombocytopenic purpura (ITP)) tends to deterioration during pregnancy and increases the risk of maternal morbidity. Corticosteroids reduce the levels of IgG and result in most women into remission, but a sustained improvement can only be achieved in 50% of cases. Immunosuppressive therapy and plasma exchange reduce the IgG further and thus increase the number of platelets. In exceptional cases, for persistent disease splenectomy is required; it is best done during the second trimester, as it then in about 80% of cases leads to a sustained remission. Since i.v. Immunoglobulins increase significantly, but only for a short time, the number of platelets, low platelet counts, the birth can be initiated under this condition in women. The transfusion of platelet concentrate is indicated if a Caesarean section should be performed and the maternal platelet counts <50,000 are / ul. Although the antiplatelet IgG crosses the placenta, it rarely causes fetal or neonatal thrombocytopenia. The maternal antiplatelet antibody levels (determined by direct or indirect immunoassay) say nothing about fetal involvement. The risk of intracranial bleeding in the newborn due to maternal immune thrombocytopenia is not affected by the type of birth, nor by birth trauma. Accordingly, the currently accepted practice is a vaginal delivery without routine determination of fetal platelet count and a cesarean section only for gynecological indications. Myasthenia gravis in pregnancy myasthenia gravis (myasthenia gravis) has different patterns during pregnancy. More frequent acute myasthenic crises may require increased doses of anti-cholinesterase agents (eg neostigmine.), Leading in some cases to symptoms of cholinergic over-reaction (eg, abdominal pain, diarrhea, vomiting and increasing weakness.); then atropine would apply. Sometimes the myasthenia is refractory to standard therapy and requires corticosteroids or immunosuppressants. During childbirth, the pregnant women occasionally need respiratory support and highly sensitive to drugs that act respiratory depressant (z. B. sedatives, opiates, magnesium sulfate). As the person responsible for myasthenia IgG crosses the placenta, the newborn occurs in 20% of a myasthenia on even more common when mothers were not thymectomized. Rheumatoid arthritis during pregnancy Rheumatoid arthritis (rheumatoid arthritis (RA)) sometimes begins during pregnancy or what is even more common in childbirth. Pre-existing rheumatoid arthritis generally takes off temporarily during pregnancy in intensity. The fetus itself is not affected, but the birth may be more difficult if the hip or lumbar spine are infected pregnant women. When developing a thrust of rheumatoid arthritis during pregnancy, the initial treatment is usually in the use of prednisone. In persistent cases, other immunosuppressants may be required. Systemic lupus erythematosus (SLE) in pregnancy A SLE (systemic lupus erythematosus (SLE)) may appear for the first time during pregnancy. In women who have an unexplained stillbirth in the second trimester, a fetus with growth retardation, premature birth or recurrent fetal loss in history, later often a SLE is diagnosed. The course of pre-existing SLE during pregnancy can not be predicted, but a worsening of SLE is possible, especially immediately after birth. The disease is more favorable if the design can be delayed until the disease has been inactive for at least 6 months, the drug treatment has been set in advance, as well as high blood pressure and kidney function are normal. Complications can include fetal growth retardation increase premature birth by preeclampsia due to the maternal antibodies that cross the placenta, congenital heart block essential pre-existing renal or cardiac complications, the risk of maternal morbidity and mortality. (Usually anticardiolipin antibody or lupus anticoagulant) Increase interstitial nephritis, hypertension or the presence of circulating antiphospholipid antibodies, the risk of perinatal mortality. Newborns can have anemia, thrombocytopenia, or leukopenia; these diseases better usually in the first weeks after birth when maternal antibodies disappear. The intake of hydroxychloroquine, which was taken before conception can be continued during pregnancy. SLE flare-ups are iv usually with low-dose prednisone, pulse therapy methylprednisolone, hydroxychloroquine and / or treated azathioprine. High-dose prednisone and cyclophosphamide increased obstetric risks and are therefore reserved for severe lupus complications.

Health Life Media Team

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