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Canadian Journal of Anaesthesia

, Volume 38, Issue 6, pp 790–796 | Cite as

Systemic Lupus Erythematosus and the obstetrical patient — implications for the anaesthetist

  • Sharon R. Davies
Continuing Medical Education

Abstract

Systemic lupus erythemalosus (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.

Key words

anaesthesia: obstetrical complications: SLE 

Résumé

Le lupus érythémateux est une maladie inflammatoire chronique multisystémique avec formation d’auto-anticorps. Il survient surtout chez les femmes en âge de procréer et on peut donc le retrouver lors d’une grossesse. Les manifestations de la maladie varient en fonction de l’atteinte des différents systèmes: musculo-squelettique, rénal, hématologique, neurologique, cardiaque et respiratoire. Plusieurs patientes prennent des médicaments tels l’aspirine ou la prednisone. Pendant la grossesse, la maladie peut s’aggraver, entraînant la mort fœtale ou d’autres complications telle la pré-éclampsie. De plus, les patientes affligées d’un anticoagulant lupique peuvent saigner en période périnatale. La démarche anesthésique dépendra de l’étal clinique de la patiente et du fœtus que l’on devra évaluer avec une attention particulière portée aux organes cibles et à la médication. Avant une aneslhésie on devra si possible mesurer l’intégrité des mécanismes de la coagulation et de la fonction rénale. Le sort de la mère et du nouveau-né dépendra en partie de la composition et de la capacité d’intervention de l’équipe soignante.

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Copyright information

© Canadian Anesthesiologists 1991

Authors and Affiliations

  • Sharon R. Davies
    • 1
  1. 1.Department of AnaesthesiaWomen’s College HospitalToronto

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