Division of Pediatric Infectious Diseases and Rheumatology, Rainbow Babies and Children's Hospital.
Division of Rheumatology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
Rheumatology (Oxford). 2018 Jul 1;57(suppl_5):v18-v25. doi: 10.1093/rheumatology/key172.
This article describes three complicated cases in rheumatology and pregnancy. The first case elucidates the challenges in treating SLE in conjunction with pulmonary arterial hypertension, while the second case features an SLE-affected pregnancy with development of portal hypertension secondary to portal vein thrombosis related to APS. The third case is a pregnant woman with stable SLE who developed thrombotic microangiopathy caused by atypical haemolytic uraemic syndrome, and failed to improve despite multiple measures including biopsy and elective preterm delivery. There are grave and unique challenges for women with autoimmune disease, but adverse outcomes can sometimes be avoided with careful and multidisciplinary medical management. Pre-conception counselling with regard to medications and disease treatment should also include discussion of the advisability of pregnancy, which may be difficult for a patient, but present the best course for optimizing health outcomes.
本文描述了风湿学和妊娠领域的三个复杂病例。第一个病例阐明了在治疗合并肺动脉高压的系统性红斑狼疮时所面临的挑战，第二个病例则是与抗磷脂综合征相关的门静脉血栓形成导致门脉高压的系统性红斑狼疮妊娠，第三个病例是一位患有稳定系统性红斑狼疮的孕妇，发展为血栓性微血管病，尽管采取了包括活检和选择性早产在内的多项措施，但仍未改善。患有自身免疫性疾病的女性面临着严峻而独特的挑战，但通过仔细的多学科医疗管理，有时可以避免不良后果。在进行药物和疾病治疗的孕前咨询时，还应讨论妊娠的适宜性，这对患者来说可能很困难，但这是优化健康结果的最佳途径。
