Systemic Lupus Erythematosus Sandy Warner RNC-OB, MSN NCC review course April, 2010
Definition and history <ul><li>Chronic multisystem autoimmune disease that occurs primarily in women of childbearing age <...
Pathophysiology <ul><li>Autoimmune disease with decreased number of T cells </li></ul><ul><li>Therefore, antibodies attack...
Risk Factors <ul><li>Advanced maternal age  (>  35) </li></ul><ul><li>African American, Asian and Native Americans 3 x mor...
Symptoms <ul><li>Cutaneous – Butterfly rash, scaly patches </li></ul><ul><li>Arthritis – 90% </li></ul><ul><li>Hematologic...
Symptoms cont. <ul><li>Neurological </li></ul><ul><ul><ul><li>Seizures </li></ul></ul></ul><ul><ul><ul><li>Psychosis </li>...
Effects on Pregnancy <ul><li>Greater risk of superimposed preeclampsia </li></ul><ul><li>Renal involvement sometimes make ...
Increased risks postpartum <ul><li>DVTs and stroke due to clotting disorder </li></ul><ul><li>Sepsis </li></ul><ul><li>Pne...
Risks to Infant <ul><li>Autoimmune antibodies cross placenta </li></ul><ul><ul><li>Can bind to fetal tissue  </li></ul></u...
Management of SLE <ul><li>Multidiscipline </li></ul><ul><li>Support systems assessment  </li></ul><ul><li>Accurate history...
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Lupus review course 2010

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  • Decrease in loss due to better preconception care and multidiscipline approach. Used to be told not to get pregnant, but also MDs reluctant to prescribe BD due to role of estrogen
  • Antigen-antibody release lysosomal enzymes which cause inflammation
  • Up to 30% with APA antibodies – relates to clotting disorder Lupus anticoagulant is an APA antibody – not to be confused with SLE, also anti cardiolipin antibodies
  • Use of steroids to treat symptoms Memory loss, difficulty concentrating
  • Lesions disappear as maternal antibodies leave infant’s circulation
  • REFER – social work, rheumatology, hematology, support groups
  • Lupus review course 2010

    1. 1. Systemic Lupus Erythematosus Sandy Warner RNC-OB, MSN NCC review course April, 2010
    2. 2. Definition and history <ul><li>Chronic multisystem autoimmune disease that occurs primarily in women of childbearing age </li></ul><ul><li>Pregnancy loss rate has decreased from 43% in 1960’s to 17% by 2000 </li></ul><ul><ul><ul><ul><ul><li>(ACOG, Aug 2008, Clowse, M.E. et al) </li></ul></ul></ul></ul></ul>
    3. 3. Pathophysiology <ul><li>Autoimmune disease with decreased number of T cells </li></ul><ul><li>Therefore, antibodies attack cells forming immune complexes that result in fibrin material that is deposited in connective tissue and blood vessel walls. </li></ul><ul><li>Antigen-antibody reaction which allows serum proteins to accumulate </li></ul><ul><ul><ul><ul><ul><li>(Legun, L.A., 1999, JOGNN) </li></ul></ul></ul></ul></ul>
    4. 4. Risk Factors <ul><li>Advanced maternal age (> 35) </li></ul><ul><li>African American, Asian and Native Americans 3 x more likely than Caucasian </li></ul><ul><ul><ul><ul><ul><li>( Classen, S.R. et al, JOGNN, Vol 27, 1998) </li></ul></ul></ul></ul></ul><ul><li>Antiphospholipid antibodies more common with SLE </li></ul>
    5. 5. Symptoms <ul><li>Cutaneous – Butterfly rash, scaly patches </li></ul><ul><li>Arthritis – 90% </li></ul><ul><li>Hematological Disorders </li></ul><ul><ul><li>Clotting </li></ul></ul><ul><li>Kidney, lung and heart involvement </li></ul><ul><ul><ul><li>Proteinuria </li></ul></ul></ul><ul><ul><ul><li>Pleuritis </li></ul></ul></ul><ul><ul><ul><li>Pericarditis </li></ul></ul></ul>
    6. 6. Symptoms cont. <ul><li>Neurological </li></ul><ul><ul><ul><li>Seizures </li></ul></ul></ul><ul><ul><ul><li>Psychosis </li></ul></ul></ul><ul><ul><ul><li>Organic Brain Syndrome </li></ul></ul></ul><ul><li>Immunologic disorders </li></ul><ul><ul><li>More susceptible to infection </li></ul></ul><ul><ul><li>Antigen-antibody cycles </li></ul></ul>
    7. 7. Effects on Pregnancy <ul><li>Greater risk of superimposed preeclampsia </li></ul><ul><li>Renal involvement sometimes make diagnosis of preeclampsia hard to detect </li></ul><ul><li>Increased incidence of diabetes </li></ul><ul><ul><ul><li>Related to steroid use to treat symptoms </li></ul></ul></ul><ul><li>Increased rate of Cesarean sections </li></ul><ul><li>Increased IUGR </li></ul>
    8. 8. Increased risks postpartum <ul><li>DVTs and stroke due to clotting disorder </li></ul><ul><li>Sepsis </li></ul><ul><li>Pneumonia </li></ul><ul><li>Wound approximation can be poor due to connective tissue disorder </li></ul>
    9. 9. Risks to Infant <ul><li>Autoimmune antibodies cross placenta </li></ul><ul><ul><li>Can bind to fetal tissue </li></ul></ul><ul><ul><ul><ul><li>Skin </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Cardiac – often fatal </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Blood disorders </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Liver involvement </li></ul></ul></ul></ul><ul><ul><li>Neonatal Lupus Erythematosus </li></ul></ul><ul><ul><li>Condition associated with lesions, transient </li></ul></ul><ul><ul><li>Often disappear after birth </li></ul></ul>
    10. 10. Management of SLE <ul><li>Multidiscipline </li></ul><ul><li>Support systems assessment </li></ul><ul><li>Accurate history important </li></ul><ul><ul><li>Often multiple losses, SLE diagnosed with pregnancy </li></ul></ul><ul><ul><ul><li>PATH (proteinuria, APA syndrome, thrombocytopenia, and hypertension) </li></ul></ul></ul><ul><ul><ul><ul><ul><li>(Clause, M.E. et al, 2006, Obstetrics and Gynecology) </li></ul></ul></ul></ul></ul>

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