SlideShare a Scribd company logo
1 of 53
Download to read offline
AUTOIMMUNE DISEASES IN PREGNANCY
Dr Max Mongelli
Department of Obstetrics & Gynaecology
University of Sydney
http://drmaxmongelli.weebly.com
Autoimmune disorders:
 More common among pregnant women
 Abnormal antibodies can cross the placenta and
affect the fetus
 Pregnancy affects autoimmune diseases in
different ways
Most common conditions:
 Thyroid Disease
 Crohn’s Disease
 Ulcerative Colitis
 SLE
 Myasthenia Gravis
 Immune Thrombocytopenic Purpura
 Rheumatoid Arthritis
 Pemphigoid Gestationis
Thyroid Disease in Pregnancy
 Graves’ Disease
 Hashimotos’ Disease
Graves’ Disease
 Hyperthyroidism
 Goitre
 Ophthalmopathy
 Pretibial myxedema
 Antibodies to TSH receptor
Autoimmune diseases in pregnancy
Hashimotos’ Thyroiditis
 “Chronic autoimmune thyroiditis”
 Most common cause of hypothyroidism
 Gradual thyroid failure or goitre
 Autoimmune destruction of thyroid gland
 Sex ratio 7:1
 Antibodies against TG, TPO, TSH receptor
Diagnosis of Hyperthyroidism in
Pregnancy
 TSH < 0.01
 Raised free T4
 +/- raised free T3
 Difficult to ascertain cause in pregnancy
Causes of Hyperthyroidism in Pregnancy
 Graves’ Disease
 Gestational Transient Thyrotoxicosis - HCG
mediated
 Molar pregnancy
 Familial gestational thyrotoxicosis
Hyperthyroidism in Pregnancy
Increased risk of -
 Miscarriage
 Premature labour
 Low birth weight
 Stillbirth
 Pre-eclampsia
 Heart failure
Hypothyroidism in Pregnancy
 Usually subclinical rather than overt
 PET and PIH
 Placental abruption
 Non-reassuring CTG
 Preterm delivery
 Increased risk of C/S
 PPH
Thyroid Peroxidase (TPO) Antibodies
 Increased risk of miscarriage
 Increased risk of preterm delivery
 20% develop hypothyroidism if untreated
 Risks may be reduced by T4 therapy
Autoimmune diseases in pregnancy
T4 therapy in pregnancy:
 Hypothyroid women need more T4
replacement
 As much as 50% dose increase
 Aim at normalising the TSH levels
 Important for normal fetal cognitive
development
Postpartum Thyroiditis:
 Occurs in 5-10% of all pregnancies
 May occur after delivery or pregnancy loss
 May decrease milk volume
 Transient hyperthyroidism followed by
transient hypothyroidism
 May recur in subsequent pregnancies
 Risk may be reduced by selenium
supplements
Crohn’s Disease
Autoimmune diseases in pregnancy
Crohn’s Disease: effect of pregnancy.
 Pregnancy has no effect on disease activity
 Perianal disease not worsened by vaginal
delivery
 Fistulas may occur during pregnancy
 Elective c/s controversial
Crohn’s Disease: effect on pregnancy.
 Increased risk of preterm delivery and IUGR
 Comparable to effect of moderate smoking
 Higher risk if disease active at conception
 Careful monitoring during pregnancy
Ulcerative Colitis
Autoimmune diseases in pregnancy
Ulcerative Colitis: effect of pregnancy.
 Related to disease activity at time of conception
 If in remission at conception, likely to stay in
remission during the pregnancy
 Higher risk if disease active at conception
Course in postpartum period the same as in non-
pregnant women.
Ulcerative Colitis: effect on pregnancy.
 Controversial
 Some studies suggest increase in preterm
delivery and LBW babies
 No increase risk of stillbirth or congenital
anomalies
Ulcerative Colitis: safety of investigation.
 Flexible sigmoidoscopy safe in pregnancy
 Colonoscopy should be avoided
 X-rays should be avoided
Ulcerative Colitis: safety of treatment.
 Sulphasalazine safe during pregnancy and
breastfeeding
 5-ASA drugs (eg mesalamine) probably safe
 Glucocorticoids should not be withheld if
clinically indicated
Systemic Lupus Erythematosus
Autoimmune diseases in pregnancy
Autoimmune diseases in pregnancy
SLE features associated with high maternal
and fetal risks – pregnancy relatively
contraindicated:
 Severe pulmonary hypertension
 Restrictive lung disease
 Heart failure
 History of severe HELLP or PET
 Stroke within previous 6/12
 Lupus flare within previous 6/12
SLE complications in pregnancy:
 Disease exacerbation
 Miscarriage, stillbirth
 IUGR, preterm labour
 Neonatal lupus
 Drugs and breast-feeding
Neonatal Lupus:
 Occurs in up to 2% of mothers with SLE
 Targets skin and cardiac tissue,rarely other tissues
 Congenital partial or complete heart block
 Heart block detected in utero
 Complete heart block: PNM of 44%
 Rash: erythematous annular lesions
 Rash clears within 6/12
 Maternal dexamethasone may prevent progression
of heart block
 Neonatal pacemaker if HR<55
Antiphospholipid antibodies
 Anti-cardiolipin
 Lupus anticoagulant
 Increased risk of miscarriage
 Risk may be reduced with aspirin +
heparin
Investigations for SLE in pregnancy:
 Physical examination and BP
 FBC, renal function
 Anti-Ro/SSA abs and anti-La/SSB abs
 LA and aCL assays
 Anti-dsDNA abs
 Complement
Myasthenia Gravis
Myasthenia Gravis:
 Typically presents with fluctuating skeletal
muscular weakness
 May be ocular or generalised
 May have antibodies to the AChR
 10-15% have a thymoma
 Respiratory muscle involvement may lead
to respiratory failure
Myasthenia Gravis in Pregnancy:
 Pregnancy has a variable effect on the
course of MG
 Post-partum exacerbations in 30%
 Infections can trigger exacerbations
 Steroids can cause transient worsening
 MgSO4 is contraindicated
Myasthenia Gravis – Effect on the Fetus
 Transplacental passage of IgG anti-AChR
 Neuromuscular junction disorders
Transient neonatal MG in 10-20%
 Decreased FM’s and breathing
 Polyhydramnios
 Arthrogryposis multiplex congenita
Myasthenia Gravis – Labour & Delivery
 First stage of labour not affected
 Second stage: expulsive efforts may
weaken
 Assisted vaginal delivery may be indicated
 Pre-labour anaesthetic assessment
indicated
Immune Thrombocytopenic Purpura
ITP
ITP – Diagnostic Criteria:
 Isolated thrombocytopenia
 No drugs or other conditions that may
affect platelet count
 Exclude HIV, Hep C, SLE
ITP – Pathology:
 Increased platelet destruction
 Inhibition of platelet production at
megakaryocyte level
 Mediated by IgG Abs against platelet
membrane glycoproteins
 Usually a chronic condition
ITP – Clinical Features:
 Petechiae, purpura, easy bruising
 Epistaxis, menorrhagia, bleeding from
gums
 GIT bleeding, hematuria: rare
 Intracranial hemorrhage – very rare
ITP and Pregnancy
 May affect fetus in up to 15% of cases
 Neonatal count may drop sharply several days after
birth
 Difficult to differentiate from gestational
thrombocytopenia
 Epidurals safe if count > 50000
 Prednisone +/- IVIG if count < 50000
 Manage delivery according to standard obstetric
practice
 Avoid NSAIDS post-partum
Gestational Thrombocytopenia
 Incidence about 5%
 Occurs late in pregnancy
 Mild (>70 000)
 No fetal neonatal thrombocytopenia
 Postpartum resolution
Rheumatoid Arthritis
Rheumatoid Arthritis in Pregnancy
 Affects 1-2% of the general population
 More common in women
 RA in pregnancy is a common challenge
 Sex hormones have effects on disease activity
 70-80% of cases improve during pregnancy
 Post-partum flare common
Effect of Pregnancy on RA
 Minimal effects on fetal morbidity and
mortality
 Steroids may increase risk of IUGR and
PPROM
 Active disease correlates with lower birth
weights
Treatment of RA in Pregnancy
 Avoid NSAIDS and high dose aspirin
 Low-dose aspirin safe
 Use lowest doses of prednisone
 Sulfasalazine, hydroxychloroquine in
refractory cases
RA Medications and Breast-feeding –
Avoid:
 Aspirin
 Azathioprine
 Cyclosporin
 Cyclophosphamide
 Methotrexate
 Chlorambucil
 High dose prednisone
Pemphigoid Gestationis
Pemphigoid Gestationis
 Blistering disease associated with increased fetal risk
 Incidence 1:1700 to 1: 50000 pregnancies
 Associated with HLA-DR3 and HLA-DR4
 Caused by IgG1 against basement membrane of skin
 Bullous pemphigoid antigen 2
 Eosinophilic infiltration
Pemphigoid Gestationis – Fetal Risks
 Preterm delivery in 1/3 of cases
 SGA in 1/3 of cases
 Worse prognosis if onset in 1st
or 2nd
trimesters
 Neonatal pemphigoid in up to 10%
 Mild disease that resolves in weeks
Autoimmune diseases in pregnancy

More Related Content

What's hot

Anti phospholipids
Anti phospholipidsAnti phospholipids
Anti phospholipidsAli Alsarhan
 
Obstetric antiphospholipid antibody syndrome
Obstetric antiphospholipid  antibody syndrome Obstetric antiphospholipid  antibody syndrome
Obstetric antiphospholipid antibody syndrome Aboubakr Elnashar
 
Hypertensive Disorder of Pregnancy
 	Hypertensive Disorder of Pregnancy			 	Hypertensive Disorder of Pregnancy
Hypertensive Disorder of Pregnancy golden4host
 
Thyroid diseases in pregnancy
Thyroid diseases in pregnancyThyroid diseases in pregnancy
Thyroid diseases in pregnancyikramdr01
 
Hyperthyroidism-2022.pptx
Hyperthyroidism-2022.pptxHyperthyroidism-2022.pptx
Hyperthyroidism-2022.pptxPrudhviKilaru
 
Pregnancy and Liver Diseases
Pregnancy and Liver DiseasesPregnancy and Liver Diseases
Pregnancy and Liver DiseasesAbdullah Ansari
 
Management of Sickle Cell Disease in Pregnancy
Management of Sickle Cell Disease in PregnancyManagement of Sickle Cell Disease in Pregnancy
Management of Sickle Cell Disease in PregnancyApollo Hospitals
 
Graves disease
Graves diseaseGraves disease
Graves diseasenak66
 
Acog hemorragia posparto acog 2017
Acog hemorragia posparto acog 2017Acog hemorragia posparto acog 2017
Acog hemorragia posparto acog 2017Clinica Robles S.A.C
 
Approach to Cyanotic Congenital Heart Diseases
Approach to Cyanotic Congenital Heart DiseasesApproach to Cyanotic Congenital Heart Diseases
Approach to Cyanotic Congenital Heart DiseasesCSN Vittal
 
Preterm Labour and Premature Rupture of Membranes Mob: 7289915430, www.drprad...
Preterm Labour and Premature Rupture of Membranes Mob: 7289915430, www.drprad...Preterm Labour and Premature Rupture of Membranes Mob: 7289915430, www.drprad...
Preterm Labour and Premature Rupture of Membranes Mob: 7289915430, www.drprad...Pradeep Garg
 

What's hot (20)

Obstetrics sepsis
Obstetrics sepsisObstetrics sepsis
Obstetrics sepsis
 
Anti phospholipids
Anti phospholipidsAnti phospholipids
Anti phospholipids
 
Obstetric antiphospholipid antibody syndrome
Obstetric antiphospholipid  antibody syndrome Obstetric antiphospholipid  antibody syndrome
Obstetric antiphospholipid antibody syndrome
 
Hypertensive Disorder of Pregnancy
 	Hypertensive Disorder of Pregnancy			 	Hypertensive Disorder of Pregnancy
Hypertensive Disorder of Pregnancy
 
Antenatal steroid
Antenatal steroidAntenatal steroid
Antenatal steroid
 
Asthma in pregnancy
Asthma in pregnancyAsthma in pregnancy
Asthma in pregnancy
 
Thyroid diseases in pregnancy
Thyroid diseases in pregnancyThyroid diseases in pregnancy
Thyroid diseases in pregnancy
 
Hyperthyroidism-2022.pptx
Hyperthyroidism-2022.pptxHyperthyroidism-2022.pptx
Hyperthyroidism-2022.pptx
 
GESTOSES part1
GESTOSES part1GESTOSES part1
GESTOSES part1
 
Hyperthyroidism
HyperthyroidismHyperthyroidism
Hyperthyroidism
 
Thyroiditis
ThyroiditisThyroiditis
Thyroiditis
 
Dyslipidemia overview 2017
Dyslipidemia overview 2017Dyslipidemia overview 2017
Dyslipidemia overview 2017
 
Pregnancy and Liver Diseases
Pregnancy and Liver DiseasesPregnancy and Liver Diseases
Pregnancy and Liver Diseases
 
Management of Sickle Cell Disease in Pregnancy
Management of Sickle Cell Disease in PregnancyManagement of Sickle Cell Disease in Pregnancy
Management of Sickle Cell Disease in Pregnancy
 
Thalassemia and Pregnancy
Thalassemia and PregnancyThalassemia and Pregnancy
Thalassemia and Pregnancy
 
Graves disease
Graves diseaseGraves disease
Graves disease
 
Hypothyrodism
HypothyrodismHypothyrodism
Hypothyrodism
 
Acog hemorragia posparto acog 2017
Acog hemorragia posparto acog 2017Acog hemorragia posparto acog 2017
Acog hemorragia posparto acog 2017
 
Approach to Cyanotic Congenital Heart Diseases
Approach to Cyanotic Congenital Heart DiseasesApproach to Cyanotic Congenital Heart Diseases
Approach to Cyanotic Congenital Heart Diseases
 
Preterm Labour and Premature Rupture of Membranes Mob: 7289915430, www.drprad...
Preterm Labour and Premature Rupture of Membranes Mob: 7289915430, www.drprad...Preterm Labour and Premature Rupture of Membranes Mob: 7289915430, www.drprad...
Preterm Labour and Premature Rupture of Membranes Mob: 7289915430, www.drprad...
 

Viewers also liked

HYPOTHYROIDISM IN PREGNACY: COMMON DILEMMAS, Dr. Jyoti Bhaskar
HYPOTHYROIDISM IN PREGNACY:COMMON DILEMMAS, Dr. Jyoti Bhaskar HYPOTHYROIDISM IN PREGNACY:COMMON DILEMMAS, Dr. Jyoti Bhaskar
HYPOTHYROIDISM IN PREGNACY: COMMON DILEMMAS, Dr. Jyoti Bhaskar Lifecare Centre
 
The ABC of Evidence-Base Medicine
The ABC of Evidence-Base MedicineThe ABC of Evidence-Base Medicine
The ABC of Evidence-Base MedicineDr Max Mongelli
 
An investigation-of-fetal-growth-in-relation-to-pregnancy-characteristics
An investigation-of-fetal-growth-in-relation-to-pregnancy-characteristicsAn investigation-of-fetal-growth-in-relation-to-pregnancy-characteristics
An investigation-of-fetal-growth-in-relation-to-pregnancy-characteristicsDr Max Mongelli
 
Thyroid dysfunction dr. mohammed ibrahim youssef (1)(1)
Thyroid dysfunction dr. mohammed  ibrahim youssef (1)(1)Thyroid dysfunction dr. mohammed  ibrahim youssef (1)(1)
Thyroid dysfunction dr. mohammed ibrahim youssef (1)(1)DR.Mohamed Ibrahim youssef
 
HIV-PEP HELPLINE FOR HEALTH PROFFESSIONALS
HIV-PEP HELPLINE FOR HEALTH PROFFESSIONALSHIV-PEP HELPLINE FOR HEALTH PROFFESSIONALS
HIV-PEP HELPLINE FOR HEALTH PROFFESSIONALSNARENDRA MALHOTRA
 
WHEN TO REFER A PATIENT FOR ASSISTED REPRODUCTION ( ART ) / IVF BY DR SHASHW...
WHEN TO REFER A PATIENT FOR ASSISTED REPRODUCTION ( ART )  / IVF BY DR SHASHW...WHEN TO REFER A PATIENT FOR ASSISTED REPRODUCTION ( ART )  / IVF BY DR SHASHW...
WHEN TO REFER A PATIENT FOR ASSISTED REPRODUCTION ( ART ) / IVF BY DR SHASHW...DR SHASHWAT JANI
 
PORTABLE STORAGE SOLUTIONS - HARD DRIVES AND FLASH DRIVES BY DR SHASHWAT JANI
PORTABLE STORAGE SOLUTIONS - HARD DRIVES AND FLASH DRIVES BY DR SHASHWAT JANIPORTABLE STORAGE SOLUTIONS - HARD DRIVES AND FLASH DRIVES BY DR SHASHWAT JANI
PORTABLE STORAGE SOLUTIONS - HARD DRIVES AND FLASH DRIVES BY DR SHASHWAT JANIDR SHASHWAT JANI
 
A Case of T2DM & Hypothyroidism with 7 Months Pregnancy Requiring Very High I...
A Case of T2DM & Hypothyroidism with 7 Months Pregnancy Requiring Very High I...A Case of T2DM & Hypothyroidism with 7 Months Pregnancy Requiring Very High I...
A Case of T2DM & Hypothyroidism with 7 Months Pregnancy Requiring Very High I...Kamrul Hasan (Ranga)
 
Normal and abnormal fetal growth
Normal and abnormal fetal growthNormal and abnormal fetal growth
Normal and abnormal fetal growthDr Max Mongelli
 
Subclinical hypothyroidism in pregnancy
Subclinical hypothyroidism in pregnancySubclinical hypothyroidism in pregnancy
Subclinical hypothyroidism in pregnancyDilek Gogas Yavuz
 
ANEMIA IN PREGNANCY BY DR SHASHWAT JANI
ANEMIA IN PREGNANCY BY DR SHASHWAT JANIANEMIA IN PREGNANCY BY DR SHASHWAT JANI
ANEMIA IN PREGNANCY BY DR SHASHWAT JANIDR SHASHWAT JANI
 
Case presntation -Anamia in Pregnancy-Case Review
Case presntation -Anamia in Pregnancy-Case ReviewCase presntation -Anamia in Pregnancy-Case Review
Case presntation -Anamia in Pregnancy-Case ReviewTana Kiak
 
Thyroid disease in pregnancy
Thyroid disease in pregnancy Thyroid disease in pregnancy
Thyroid disease in pregnancy Archana Tandon
 
BLOOD & BLOOD COMPONENTS IN OBSTETRICS BY DR SHASHWAT JANI
BLOOD & BLOOD COMPONENTS IN OBSTETRICS  BY DR SHASHWAT JANIBLOOD & BLOOD COMPONENTS IN OBSTETRICS  BY DR SHASHWAT JANI
BLOOD & BLOOD COMPONENTS IN OBSTETRICS BY DR SHASHWAT JANIDR SHASHWAT JANI
 
MICRONUTRIENTS IN MALE INFERTILITY BY DR SHASHWAT JANI
MICRONUTRIENTS IN MALE INFERTILITY BY DR SHASHWAT JANIMICRONUTRIENTS IN MALE INFERTILITY BY DR SHASHWAT JANI
MICRONUTRIENTS IN MALE INFERTILITY BY DR SHASHWAT JANIDR SHASHWAT JANI
 

Viewers also liked (20)

HYPOTHYROIDISM IN PREGNACY: COMMON DILEMMAS, Dr. Jyoti Bhaskar
HYPOTHYROIDISM IN PREGNACY:COMMON DILEMMAS, Dr. Jyoti Bhaskar HYPOTHYROIDISM IN PREGNACY:COMMON DILEMMAS, Dr. Jyoti Bhaskar
HYPOTHYROIDISM IN PREGNACY: COMMON DILEMMAS, Dr. Jyoti Bhaskar
 
The ABC of Evidence-Base Medicine
The ABC of Evidence-Base MedicineThe ABC of Evidence-Base Medicine
The ABC of Evidence-Base Medicine
 
An investigation-of-fetal-growth-in-relation-to-pregnancy-characteristics
An investigation-of-fetal-growth-in-relation-to-pregnancy-characteristicsAn investigation-of-fetal-growth-in-relation-to-pregnancy-characteristics
An investigation-of-fetal-growth-in-relation-to-pregnancy-characteristics
 
Thyroid dysfunction dr. mohammed ibrahim youssef (1)(1)
Thyroid dysfunction dr. mohammed  ibrahim youssef (1)(1)Thyroid dysfunction dr. mohammed  ibrahim youssef (1)(1)
Thyroid dysfunction dr. mohammed ibrahim youssef (1)(1)
 
HIV-PEP HELPLINE FOR HEALTH PROFFESSIONALS
HIV-PEP HELPLINE FOR HEALTH PROFFESSIONALSHIV-PEP HELPLINE FOR HEALTH PROFFESSIONALS
HIV-PEP HELPLINE FOR HEALTH PROFFESSIONALS
 
WHEN TO REFER A PATIENT FOR ASSISTED REPRODUCTION ( ART ) / IVF BY DR SHASHW...
WHEN TO REFER A PATIENT FOR ASSISTED REPRODUCTION ( ART )  / IVF BY DR SHASHW...WHEN TO REFER A PATIENT FOR ASSISTED REPRODUCTION ( ART )  / IVF BY DR SHASHW...
WHEN TO REFER A PATIENT FOR ASSISTED REPRODUCTION ( ART ) / IVF BY DR SHASHW...
 
Near miss
Near missNear miss
Near miss
 
PORTABLE STORAGE SOLUTIONS - HARD DRIVES AND FLASH DRIVES BY DR SHASHWAT JANI
PORTABLE STORAGE SOLUTIONS - HARD DRIVES AND FLASH DRIVES BY DR SHASHWAT JANIPORTABLE STORAGE SOLUTIONS - HARD DRIVES AND FLASH DRIVES BY DR SHASHWAT JANI
PORTABLE STORAGE SOLUTIONS - HARD DRIVES AND FLASH DRIVES BY DR SHASHWAT JANI
 
A Case of T2DM & Hypothyroidism with 7 Months Pregnancy Requiring Very High I...
A Case of T2DM & Hypothyroidism with 7 Months Pregnancy Requiring Very High I...A Case of T2DM & Hypothyroidism with 7 Months Pregnancy Requiring Very High I...
A Case of T2DM & Hypothyroidism with 7 Months Pregnancy Requiring Very High I...
 
Normal and abnormal fetal growth
Normal and abnormal fetal growthNormal and abnormal fetal growth
Normal and abnormal fetal growth
 
Subclinical hypothyroidism in pregnancy
Subclinical hypothyroidism in pregnancySubclinical hypothyroidism in pregnancy
Subclinical hypothyroidism in pregnancy
 
ANEMIA IN PREGNANCY BY DR SHASHWAT JANI
ANEMIA IN PREGNANCY BY DR SHASHWAT JANIANEMIA IN PREGNANCY BY DR SHASHWAT JANI
ANEMIA IN PREGNANCY BY DR SHASHWAT JANI
 
Case presntation -Anamia in Pregnancy-Case Review
Case presntation -Anamia in Pregnancy-Case ReviewCase presntation -Anamia in Pregnancy-Case Review
Case presntation -Anamia in Pregnancy-Case Review
 
Thyroid disease in pregnancy
Thyroid disease in pregnancy Thyroid disease in pregnancy
Thyroid disease in pregnancy
 
BLOOD & BLOOD COMPONENTS IN OBSTETRICS BY DR SHASHWAT JANI
BLOOD & BLOOD COMPONENTS IN OBSTETRICS  BY DR SHASHWAT JANIBLOOD & BLOOD COMPONENTS IN OBSTETRICS  BY DR SHASHWAT JANI
BLOOD & BLOOD COMPONENTS IN OBSTETRICS BY DR SHASHWAT JANI
 
Thyroid in pregnancy
Thyroid in pregnancyThyroid in pregnancy
Thyroid in pregnancy
 
Thyroid final
Thyroid finalThyroid final
Thyroid final
 
MICRONUTRIENTS IN MALE INFERTILITY BY DR SHASHWAT JANI
MICRONUTRIENTS IN MALE INFERTILITY BY DR SHASHWAT JANIMICRONUTRIENTS IN MALE INFERTILITY BY DR SHASHWAT JANI
MICRONUTRIENTS IN MALE INFERTILITY BY DR SHASHWAT JANI
 
Anaemia in pregnancy
Anaemia in pregnancyAnaemia in pregnancy
Anaemia in pregnancy
 
My anemia case presentation
My anemia case presentationMy anemia case presentation
My anemia case presentation
 

Similar to Autoimmune diseases in pregnancy

Autoimmune diseases in pregnancy
Autoimmune diseases in pregnancyAutoimmune diseases in pregnancy
Autoimmune diseases in pregnancyDr Max Mongelli
 
Pregnancy with rheumatic diseases
Pregnancy with rheumatic diseasesPregnancy with rheumatic diseases
Pregnancy with rheumatic diseasesMarwa Besar
 
HIGH RISK PREGNANCY TRAINING FOR ANM
HIGH RISK PREGNANCY TRAINING FOR ANM HIGH RISK PREGNANCY TRAINING FOR ANM
HIGH RISK PREGNANCY TRAINING FOR ANM Dr. Animesh Das
 
(Eng) pregnancy induced hypertension
(Eng) pregnancy induced hypertension(Eng) pregnancy induced hypertension
(Eng) pregnancy induced hypertensionRyan Mulyana
 
Pregnancy, Dentistry and surgery
Pregnancy, Dentistry and surgeryPregnancy, Dentistry and surgery
Pregnancy, Dentistry and surgeryBinaya Subedi
 
Pregnancy and renal transplantation
Pregnancy and renal transplantation Pregnancy and renal transplantation
Pregnancy and renal transplantation Mohamed Abdel-Monem
 
(Eng) pregnancy induced hypertension (1)
(Eng) pregnancy induced hypertension (1)(Eng) pregnancy induced hypertension (1)
(Eng) pregnancy induced hypertension (1)Ryan Mulyana
 
Htn And Renal Dz In Pregnancy No Questions
Htn And Renal Dz In Pregnancy No QuestionsHtn And Renal Dz In Pregnancy No Questions
Htn And Renal Dz In Pregnancy No Questionsguest6940925
 
임신과 관련된 위장관 질환
임신과 관련된 위장관 질환임신과 관련된 위장관 질환
임신과 관련된 위장관 질환mothersafe
 
Polikistik Over Sendromu - PCOS - www.jinekolojivegebelik.com
Polikistik Over Sendromu - PCOS - www.jinekolojivegebelik.comPolikistik Over Sendromu - PCOS - www.jinekolojivegebelik.com
Polikistik Over Sendromu - PCOS - www.jinekolojivegebelik.comjinekolojivegebelik.com
 
Vaginal bleeding du ing pregnancy (2)
Vaginal bleeding du ing pregnancy (2)Vaginal bleeding du ing pregnancy (2)
Vaginal bleeding du ing pregnancy (2)bsnguyenhongchau
 
Vaginal bleeding du ing pregnancy (1)
Vaginal bleeding du ing pregnancy (1)Vaginal bleeding du ing pregnancy (1)
Vaginal bleeding du ing pregnancy (1)bsnguyenhongchau
 
Renal transplantation and pregnancy
Renal transplantation and pregnancyRenal transplantation and pregnancy
Renal transplantation and pregnancySalwa Ibrahim
 
CME Hypertension in Pregnancy.pdf
CME Hypertension in Pregnancy.pdfCME Hypertension in Pregnancy.pdf
CME Hypertension in Pregnancy.pdfyogeswary7
 
Pregnant lady in icu 2017
Pregnant lady in icu 2017Pregnant lady in icu 2017
Pregnant lady in icu 2017Mohamed Gamal
 

Similar to Autoimmune diseases in pregnancy (20)

Autoimmune diseases in pregnancy
Autoimmune diseases in pregnancyAutoimmune diseases in pregnancy
Autoimmune diseases in pregnancy
 
Pregnancy with rheumatic diseases
Pregnancy with rheumatic diseasesPregnancy with rheumatic diseases
Pregnancy with rheumatic diseases
 
HIGH RISK PREGNANCY TRAINING FOR ANM
HIGH RISK PREGNANCY TRAINING FOR ANM HIGH RISK PREGNANCY TRAINING FOR ANM
HIGH RISK PREGNANCY TRAINING FOR ANM
 
(Eng) pregnancy induced hypertension
(Eng) pregnancy induced hypertension(Eng) pregnancy induced hypertension
(Eng) pregnancy induced hypertension
 
Vte in pregnancy (written)
Vte in pregnancy (written)Vte in pregnancy (written)
Vte in pregnancy (written)
 
Pregnancy, Dentistry and surgery
Pregnancy, Dentistry and surgeryPregnancy, Dentistry and surgery
Pregnancy, Dentistry and surgery
 
Pregnancy and renal transplantation
Pregnancy and renal transplantation Pregnancy and renal transplantation
Pregnancy and renal transplantation
 
(Eng) pregnancy induced hypertension (1)
(Eng) pregnancy induced hypertension (1)(Eng) pregnancy induced hypertension (1)
(Eng) pregnancy induced hypertension (1)
 
Htn And Renal Dz In Pregnancy No Questions
Htn And Renal Dz In Pregnancy No QuestionsHtn And Renal Dz In Pregnancy No Questions
Htn And Renal Dz In Pregnancy No Questions
 
Abortion
AbortionAbortion
Abortion
 
Thyroid disease in pregnancy
Thyroid disease in pregnancyThyroid disease in pregnancy
Thyroid disease in pregnancy
 
임신과 관련된 위장관 질환
임신과 관련된 위장관 질환임신과 관련된 위장관 질환
임신과 관련된 위장관 질환
 
Polikistik Over Sendromu - PCOS - www.jinekolojivegebelik.com
Polikistik Over Sendromu - PCOS - www.jinekolojivegebelik.comPolikistik Over Sendromu - PCOS - www.jinekolojivegebelik.com
Polikistik Over Sendromu - PCOS - www.jinekolojivegebelik.com
 
Vaginal bleeding du ing pregnancy (2)
Vaginal bleeding du ing pregnancy (2)Vaginal bleeding du ing pregnancy (2)
Vaginal bleeding du ing pregnancy (2)
 
Vaginal bleeding du ing pregnancy (1)
Vaginal bleeding du ing pregnancy (1)Vaginal bleeding du ing pregnancy (1)
Vaginal bleeding du ing pregnancy (1)
 
Renal transplantation and pregnancy
Renal transplantation and pregnancyRenal transplantation and pregnancy
Renal transplantation and pregnancy
 
CME Hypertension in Pregnancy.pdf
CME Hypertension in Pregnancy.pdfCME Hypertension in Pregnancy.pdf
CME Hypertension in Pregnancy.pdf
 
Pregnant lady in icu 2017
Pregnant lady in icu 2017Pregnant lady in icu 2017
Pregnant lady in icu 2017
 
Preterm labour
Preterm labourPreterm labour
Preterm labour
 
Renal disorders in pregnancy
Renal disorders in pregnancyRenal disorders in pregnancy
Renal disorders in pregnancy
 

More from Dr Max Mongelli

An investigation-of-fetal-growth-in-relation-to-pregnancy-characteristics
An investigation-of-fetal-growth-in-relation-to-pregnancy-characteristicsAn investigation-of-fetal-growth-in-relation-to-pregnancy-characteristics
An investigation-of-fetal-growth-in-relation-to-pregnancy-characteristicsDr Max Mongelli
 
Why do mothers die in pregnancy
Why do mothers die in pregnancyWhy do mothers die in pregnancy
Why do mothers die in pregnancyDr Max Mongelli
 
Why do mothers bleed in pregnancy
Why do mothers bleed in pregnancyWhy do mothers bleed in pregnancy
Why do mothers bleed in pregnancyDr Max Mongelli
 
Assessment of fetal growth
Assessment of fetal growthAssessment of fetal growth
Assessment of fetal growthDr Max Mongelli
 

More from Dr Max Mongelli (9)

An investigation-of-fetal-growth-in-relation-to-pregnancy-characteristics
An investigation-of-fetal-growth-in-relation-to-pregnancy-characteristicsAn investigation-of-fetal-growth-in-relation-to-pregnancy-characteristics
An investigation-of-fetal-growth-in-relation-to-pregnancy-characteristics
 
Why do mothers die in pregnancy
Why do mothers die in pregnancyWhy do mothers die in pregnancy
Why do mothers die in pregnancy
 
Why do mothers bleed in pregnancy
Why do mothers bleed in pregnancyWhy do mothers bleed in pregnancy
Why do mothers bleed in pregnancy
 
Postpartum Hemorrhage
Postpartum HemorrhagePostpartum Hemorrhage
Postpartum Hemorrhage
 
Preterm Labor
Preterm LaborPreterm Labor
Preterm Labor
 
Assessment of fetal growth
Assessment of fetal growthAssessment of fetal growth
Assessment of fetal growth
 
Post term pregnancy
Post term pregnancyPost term pregnancy
Post term pregnancy
 
Vaginal discharge
Vaginal dischargeVaginal discharge
Vaginal discharge
 
Induction of labour
Induction of labourInduction of labour
Induction of labour
 

Recently uploaded

Adenomyosis or Fibroid- making right diagnosis
Adenomyosis or Fibroid- making right diagnosisAdenomyosis or Fibroid- making right diagnosis
Adenomyosis or Fibroid- making right diagnosisSujoy Dasgupta
 
ANATOMICAL FAETURES OF BONES FOR NURSING STUDENTS .pptx
ANATOMICAL FAETURES OF BONES  FOR NURSING STUDENTS .pptxANATOMICAL FAETURES OF BONES  FOR NURSING STUDENTS .pptx
ANATOMICAL FAETURES OF BONES FOR NURSING STUDENTS .pptxWINCY THIRUMURUGAN
 
Male Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy DasguptaMale Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy DasguptaSujoy Dasgupta
 
power point presentation of Clinical evaluation of strabismus
power point presentation of Clinical evaluation  of strabismuspower point presentation of Clinical evaluation  of strabismus
power point presentation of Clinical evaluation of strabismusChandrasekar Reddy
 
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.Bulimia nervosa ( Eating Disorders) Mental Health Nursing.
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.aarjukhadka22
 
CPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing studentCPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing studentsaileshpanda05
 
EXERCISE PERFORMANCE.pptx, Lung function
EXERCISE PERFORMANCE.pptx, Lung functionEXERCISE PERFORMANCE.pptx, Lung function
EXERCISE PERFORMANCE.pptx, Lung functionkrishnareddy157915
 
Unit I herbs as raw materials, biodynamic agriculture.ppt
Unit I herbs as raw materials, biodynamic agriculture.pptUnit I herbs as raw materials, biodynamic agriculture.ppt
Unit I herbs as raw materials, biodynamic agriculture.pptPradnya Wadekar
 
AORTIC DISSECTION and management of aortic dissection
AORTIC DISSECTION and management of aortic dissectionAORTIC DISSECTION and management of aortic dissection
AORTIC DISSECTION and management of aortic dissectiondrhanifmohdali
 
blood bank management system project report
blood bank management system project reportblood bank management system project report
blood bank management system project reportNARMADAPETROLEUMGAS
 
Neurological history taking (2024) .
Neurological  history  taking  (2024)  .Neurological  history  taking  (2024)  .
Neurological history taking (2024) .Mohamed Rizk Khodair
 
Red Blood Cells_anemia & polycythemia.pdf
Red Blood Cells_anemia & polycythemia.pdfRed Blood Cells_anemia & polycythemia.pdf
Red Blood Cells_anemia & polycythemia.pdfMedicoseAcademics
 
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdf
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdfSGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdf
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdfHongBiThi1
 
Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.Vaikunthan Rajaratnam
 
Basic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptxBasic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptxkomalt2001
 
Physiology of Smooth Muscles -Mechanics of contraction and relaxation
Physiology of Smooth Muscles -Mechanics of contraction and relaxationPhysiology of Smooth Muscles -Mechanics of contraction and relaxation
Physiology of Smooth Muscles -Mechanics of contraction and relaxationMedicoseAcademics
 
Pharmacokinetic Models by Dr. Ram D. Bawankar.ppt
Pharmacokinetic Models by Dr. Ram D.  Bawankar.pptPharmacokinetic Models by Dr. Ram D.  Bawankar.ppt
Pharmacokinetic Models by Dr. Ram D. Bawankar.pptRamDBawankar1
 
How to cure cirrhosis and chronic hepatitis naturally
How to cure cirrhosis and chronic hepatitis naturallyHow to cure cirrhosis and chronic hepatitis naturally
How to cure cirrhosis and chronic hepatitis naturallyZurück zum Ursprung
 

Recently uploaded (20)

Adenomyosis or Fibroid- making right diagnosis
Adenomyosis or Fibroid- making right diagnosisAdenomyosis or Fibroid- making right diagnosis
Adenomyosis or Fibroid- making right diagnosis
 
ANATOMICAL FAETURES OF BONES FOR NURSING STUDENTS .pptx
ANATOMICAL FAETURES OF BONES  FOR NURSING STUDENTS .pptxANATOMICAL FAETURES OF BONES  FOR NURSING STUDENTS .pptx
ANATOMICAL FAETURES OF BONES FOR NURSING STUDENTS .pptx
 
Male Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy DasguptaMale Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy Dasgupta
 
power point presentation of Clinical evaluation of strabismus
power point presentation of Clinical evaluation  of strabismuspower point presentation of Clinical evaluation  of strabismus
power point presentation of Clinical evaluation of strabismus
 
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.Bulimia nervosa ( Eating Disorders) Mental Health Nursing.
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.
 
Biologic therapy ice breaking in rheumatology, Case based approach with appli...
Biologic therapy ice breaking in rheumatology, Case based approach with appli...Biologic therapy ice breaking in rheumatology, Case based approach with appli...
Biologic therapy ice breaking in rheumatology, Case based approach with appli...
 
CPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing studentCPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing student
 
EXERCISE PERFORMANCE.pptx, Lung function
EXERCISE PERFORMANCE.pptx, Lung functionEXERCISE PERFORMANCE.pptx, Lung function
EXERCISE PERFORMANCE.pptx, Lung function
 
Unit I herbs as raw materials, biodynamic agriculture.ppt
Unit I herbs as raw materials, biodynamic agriculture.pptUnit I herbs as raw materials, biodynamic agriculture.ppt
Unit I herbs as raw materials, biodynamic agriculture.ppt
 
AORTIC DISSECTION and management of aortic dissection
AORTIC DISSECTION and management of aortic dissectionAORTIC DISSECTION and management of aortic dissection
AORTIC DISSECTION and management of aortic dissection
 
blood bank management system project report
blood bank management system project reportblood bank management system project report
blood bank management system project report
 
Neurological history taking (2024) .
Neurological  history  taking  (2024)  .Neurological  history  taking  (2024)  .
Neurological history taking (2024) .
 
Red Blood Cells_anemia & polycythemia.pdf
Red Blood Cells_anemia & polycythemia.pdfRed Blood Cells_anemia & polycythemia.pdf
Red Blood Cells_anemia & polycythemia.pdf
 
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdf
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdfSGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdf
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdf
 
Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.
 
Basic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptxBasic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptx
 
Physiology of Smooth Muscles -Mechanics of contraction and relaxation
Physiology of Smooth Muscles -Mechanics of contraction and relaxationPhysiology of Smooth Muscles -Mechanics of contraction and relaxation
Physiology of Smooth Muscles -Mechanics of contraction and relaxation
 
Pharmacokinetic Models by Dr. Ram D. Bawankar.ppt
Pharmacokinetic Models by Dr. Ram D.  Bawankar.pptPharmacokinetic Models by Dr. Ram D.  Bawankar.ppt
Pharmacokinetic Models by Dr. Ram D. Bawankar.ppt
 
GOUT UPDATE AHMED YEHIA 2024, case based approach with application of the lat...
GOUT UPDATE AHMED YEHIA 2024, case based approach with application of the lat...GOUT UPDATE AHMED YEHIA 2024, case based approach with application of the lat...
GOUT UPDATE AHMED YEHIA 2024, case based approach with application of the lat...
 
How to cure cirrhosis and chronic hepatitis naturally
How to cure cirrhosis and chronic hepatitis naturallyHow to cure cirrhosis and chronic hepatitis naturally
How to cure cirrhosis and chronic hepatitis naturally
 

Autoimmune diseases in pregnancy

  • 1. AUTOIMMUNE DISEASES IN PREGNANCY Dr Max Mongelli Department of Obstetrics & Gynaecology University of Sydney http://drmaxmongelli.weebly.com
  • 2. Autoimmune disorders:  More common among pregnant women  Abnormal antibodies can cross the placenta and affect the fetus  Pregnancy affects autoimmune diseases in different ways
  • 3. Most common conditions:  Thyroid Disease  Crohn’s Disease  Ulcerative Colitis  SLE  Myasthenia Gravis  Immune Thrombocytopenic Purpura  Rheumatoid Arthritis  Pemphigoid Gestationis
  • 4. Thyroid Disease in Pregnancy  Graves’ Disease  Hashimotos’ Disease
  • 5. Graves’ Disease  Hyperthyroidism  Goitre  Ophthalmopathy  Pretibial myxedema  Antibodies to TSH receptor
  • 7. Hashimotos’ Thyroiditis  “Chronic autoimmune thyroiditis”  Most common cause of hypothyroidism  Gradual thyroid failure or goitre  Autoimmune destruction of thyroid gland  Sex ratio 7:1  Antibodies against TG, TPO, TSH receptor
  • 8. Diagnosis of Hyperthyroidism in Pregnancy  TSH < 0.01  Raised free T4  +/- raised free T3  Difficult to ascertain cause in pregnancy
  • 9. Causes of Hyperthyroidism in Pregnancy  Graves’ Disease  Gestational Transient Thyrotoxicosis - HCG mediated  Molar pregnancy  Familial gestational thyrotoxicosis
  • 10. Hyperthyroidism in Pregnancy Increased risk of -  Miscarriage  Premature labour  Low birth weight  Stillbirth  Pre-eclampsia  Heart failure
  • 11. Hypothyroidism in Pregnancy  Usually subclinical rather than overt  PET and PIH  Placental abruption  Non-reassuring CTG  Preterm delivery  Increased risk of C/S  PPH
  • 12. Thyroid Peroxidase (TPO) Antibodies  Increased risk of miscarriage  Increased risk of preterm delivery  20% develop hypothyroidism if untreated  Risks may be reduced by T4 therapy
  • 14. T4 therapy in pregnancy:  Hypothyroid women need more T4 replacement  As much as 50% dose increase  Aim at normalising the TSH levels  Important for normal fetal cognitive development
  • 15. Postpartum Thyroiditis:  Occurs in 5-10% of all pregnancies  May occur after delivery or pregnancy loss  May decrease milk volume  Transient hyperthyroidism followed by transient hypothyroidism  May recur in subsequent pregnancies  Risk may be reduced by selenium supplements
  • 18. Crohn’s Disease: effect of pregnancy.  Pregnancy has no effect on disease activity  Perianal disease not worsened by vaginal delivery  Fistulas may occur during pregnancy  Elective c/s controversial
  • 19. Crohn’s Disease: effect on pregnancy.  Increased risk of preterm delivery and IUGR  Comparable to effect of moderate smoking  Higher risk if disease active at conception  Careful monitoring during pregnancy
  • 22. Ulcerative Colitis: effect of pregnancy.  Related to disease activity at time of conception  If in remission at conception, likely to stay in remission during the pregnancy  Higher risk if disease active at conception Course in postpartum period the same as in non- pregnant women.
  • 23. Ulcerative Colitis: effect on pregnancy.  Controversial  Some studies suggest increase in preterm delivery and LBW babies  No increase risk of stillbirth or congenital anomalies
  • 24. Ulcerative Colitis: safety of investigation.  Flexible sigmoidoscopy safe in pregnancy  Colonoscopy should be avoided  X-rays should be avoided
  • 25. Ulcerative Colitis: safety of treatment.  Sulphasalazine safe during pregnancy and breastfeeding  5-ASA drugs (eg mesalamine) probably safe  Glucocorticoids should not be withheld if clinically indicated
  • 29. SLE features associated with high maternal and fetal risks – pregnancy relatively contraindicated:  Severe pulmonary hypertension  Restrictive lung disease  Heart failure  History of severe HELLP or PET  Stroke within previous 6/12  Lupus flare within previous 6/12
  • 30. SLE complications in pregnancy:  Disease exacerbation  Miscarriage, stillbirth  IUGR, preterm labour  Neonatal lupus  Drugs and breast-feeding
  • 31. Neonatal Lupus:  Occurs in up to 2% of mothers with SLE  Targets skin and cardiac tissue,rarely other tissues  Congenital partial or complete heart block  Heart block detected in utero  Complete heart block: PNM of 44%  Rash: erythematous annular lesions  Rash clears within 6/12  Maternal dexamethasone may prevent progression of heart block  Neonatal pacemaker if HR<55
  • 32. Antiphospholipid antibodies  Anti-cardiolipin  Lupus anticoagulant  Increased risk of miscarriage  Risk may be reduced with aspirin + heparin
  • 33. Investigations for SLE in pregnancy:  Physical examination and BP  FBC, renal function  Anti-Ro/SSA abs and anti-La/SSB abs  LA and aCL assays  Anti-dsDNA abs  Complement
  • 35. Myasthenia Gravis:  Typically presents with fluctuating skeletal muscular weakness  May be ocular or generalised  May have antibodies to the AChR  10-15% have a thymoma  Respiratory muscle involvement may lead to respiratory failure
  • 36. Myasthenia Gravis in Pregnancy:  Pregnancy has a variable effect on the course of MG  Post-partum exacerbations in 30%  Infections can trigger exacerbations  Steroids can cause transient worsening  MgSO4 is contraindicated
  • 37. Myasthenia Gravis – Effect on the Fetus  Transplacental passage of IgG anti-AChR  Neuromuscular junction disorders Transient neonatal MG in 10-20%  Decreased FM’s and breathing  Polyhydramnios  Arthrogryposis multiplex congenita
  • 38. Myasthenia Gravis – Labour & Delivery  First stage of labour not affected  Second stage: expulsive efforts may weaken  Assisted vaginal delivery may be indicated  Pre-labour anaesthetic assessment indicated
  • 40. ITP – Diagnostic Criteria:  Isolated thrombocytopenia  No drugs or other conditions that may affect platelet count  Exclude HIV, Hep C, SLE
  • 41. ITP – Pathology:  Increased platelet destruction  Inhibition of platelet production at megakaryocyte level  Mediated by IgG Abs against platelet membrane glycoproteins  Usually a chronic condition
  • 42. ITP – Clinical Features:  Petechiae, purpura, easy bruising  Epistaxis, menorrhagia, bleeding from gums  GIT bleeding, hematuria: rare  Intracranial hemorrhage – very rare
  • 43. ITP and Pregnancy  May affect fetus in up to 15% of cases  Neonatal count may drop sharply several days after birth  Difficult to differentiate from gestational thrombocytopenia  Epidurals safe if count > 50000  Prednisone +/- IVIG if count < 50000  Manage delivery according to standard obstetric practice  Avoid NSAIDS post-partum
  • 44. Gestational Thrombocytopenia  Incidence about 5%  Occurs late in pregnancy  Mild (>70 000)  No fetal neonatal thrombocytopenia  Postpartum resolution
  • 46. Rheumatoid Arthritis in Pregnancy  Affects 1-2% of the general population  More common in women  RA in pregnancy is a common challenge  Sex hormones have effects on disease activity  70-80% of cases improve during pregnancy  Post-partum flare common
  • 47. Effect of Pregnancy on RA  Minimal effects on fetal morbidity and mortality  Steroids may increase risk of IUGR and PPROM  Active disease correlates with lower birth weights
  • 48. Treatment of RA in Pregnancy  Avoid NSAIDS and high dose aspirin  Low-dose aspirin safe  Use lowest doses of prednisone  Sulfasalazine, hydroxychloroquine in refractory cases
  • 49. RA Medications and Breast-feeding – Avoid:  Aspirin  Azathioprine  Cyclosporin  Cyclophosphamide  Methotrexate  Chlorambucil  High dose prednisone
  • 51. Pemphigoid Gestationis  Blistering disease associated with increased fetal risk  Incidence 1:1700 to 1: 50000 pregnancies  Associated with HLA-DR3 and HLA-DR4  Caused by IgG1 against basement membrane of skin  Bullous pemphigoid antigen 2  Eosinophilic infiltration
  • 52. Pemphigoid Gestationis – Fetal Risks  Preterm delivery in 1/3 of cases  SGA in 1/3 of cases  Worse prognosis if onset in 1st or 2nd trimesters  Neonatal pemphigoid in up to 10%  Mild disease that resolves in weeks