Autoimmune disorders

complicating pregnancies

DR NUSRAT LAKHO
 Autoimmune disorders
complicating pregnancies
 1- Autoimmune thrombocytopenia
 2-Systemic lupus erythematosus
 3-Autoimmune thyrotoxicosis (grave’s
disease), hypothyroidism (hashimoto’s
thyroiditis .
 Autoimmune
thrombocytopenia
 Definition :
thrombocytopenia is defined as a low
platelet count <150 X 109 .in autoimmune
thrombocytopenia auto antibodies are
produced against platelet surface
antegens,leading to platelet destruction by
reticulo endothelial system .
 Autoimmune
thrombocytopenia
 INCIDENCE:
The incidence of immune thrombocytopenia
in pregnancy is 1 in 500 pregnancies .there
is 5-10 % chance of associated fetal
thrombocytopenia (<50X109 ) ,which can
not be predicted using maternal counts or
antibody test .
 Autoimmune
thrombocytopenia
 MANSGEMENT:
 Serial monitoring of platelet counts
,provided the count remain above 80X109
/L.
 If count falls below 50X109 in
pregnancies near term the corticosteroid
should be given for 2-3 wks .
 Autoimmune
thrombocytopenia
 MANSGEMENT:
 IgG is preferred option where rapid increase
count is required .if the duration is likely to
be prolonged or if high maintenance dose is
required .
 Fetal blood sampling ,regional analgesia
,anesthesia ,vaccum deliveries and I/M
injections should be avoided.
 Autoimmune
thrombocytopenia
MANSGEMENT:
Maternal haemorrhage is very unlikely if
platelet counts is above 50X109 .
A cord blood sample must be collected
for platelet counting then repeat testing of
neonat is also required after 2-5 days of
delivery .
SYSTEMIC LUPUS ERYTHEMATOSUS

 Systemic lupus erythematosus

(SLE ) is a chronic inflammatory diseases
,it may affect any system but principally
joints 90%,skin 80%,lungs ,CNS,kidneys
and heart .
SYSTEMIC LUPUS ERYTHEMATOSUS

 SLE characterized by periods of disease

activity ,flares and remission .pregnancy
increases the risks of flares but flares are
more common if disease is active at the
time of conception,or new–onset SLE in
pregnancy .
SYSTEMIC LUPUS ERYTHEMATOSUS

 PREGANCY OUTCOME :
 SLE is associated with significant risks
of miscarriage ,FGR,IUD ,preterm delivery
and pre eclampsia, neonatal lupus and
congenital heart block . Pregnancy outcome
is adversely affected if a woman having
lupus nephritis ,or pre existing hypertension
and antiphospholid antibodies .
SYSTEMIC LUPUS ERYTHEMATOSUS

 INCIDENCE:
SLE is 10 times more common in women
particularly in black and Asian
populations,it affects around 1 in 1000
women .
SYSTEMIC LUPUS ERYTHEMATOSUS

 DIAGNOSIS :
Positive assay for antinuclear antibodies
antibodies to double-stranded DNA
ACR classification system (if 4 of the
11 criteria are present a person is said to
have SLE .
SYSTEMIC LUPUS ERYTHEMATOSUS

 ACR CRITERIA FOR

CLASSIFICATION
OF SLE :
1- Malar rash 5-non erosive arthritis
2-dicoid rash 6-pluritis pericarditis
3- photosensitivity 7-renal disorder
4-oral ulcers 8-neurologic disorder

SYSTEMIC LUPUS ERYTHEMATOSUS

ACR CRITERIA FOR

CLASSIFICATION
OF SLE :
9-haematologic disorder
10-immunologic disorder
11-positive anti nuclear antibody
SYSTEMIC LUPUS ERYTHEMATOSUS

 management :
multidisciplinary care with frequent visits
base line renal studies including 24-hrs
urine collection for protien
Regular blood pressure recording
serial ultrasonography & umblical artery
Doppler .
SYSTEMIC LUPUS ERYTHEMATOSUS

 management :
If treatment is required in the cases
flares of disease then steroids
,azathioprine,sulphasalazine and
hydroxycloroquine can be given safely .
nonsteroidal anti inflamatory drugs
should be avoided .
 THYROID DISEASE DURING
PREGNANCY

 Thyroid disease is common in women

of child bearing age ,however ,symptoms of
thyroid disease .such as heat intolerance
,constipation ,fatigue palpitations and wt
gain resemble those of normal pregnancy .
 THYROID DISEASE DURING
PREGNANCY

 Thyroid function test should be performed

serially in each trimester or more often if
dose adjustment is required .
 THYROID DISEASE DURING
PREGNANCY

 HYPERTHYROIDISM :
autoimmune thyrotoxicoses
(Grave's disease ) affects around 2 per
1000 pregnancies and usually been
diagnosed before pregnancy .
 THYROID DISEASE DURING
PREGNANCY

 EFECTS OF HYPERTHYROIDISM ON
PREGNANCY :
 increased risks of miscarriage ,preterm
delivery ,fetal growth restriction and fetal
thyrotoxicoses .
 THYROID DISEASE DURING
PREGNANCY

 TREATMENT :
 treatment during pregnancy should be
drug therapy, aiming to maintain maternal
free T3 &T4 levels in the high /normal
range.
 Carbimazole and propylthiouracil ,in the
lowest effective dose
 THYROID DISEASE DURING
PREGNANCY

HYPOTHYROIDISM :
 hypothyroidism is found in 1% of pregnant
women .worldwide, the commonest cause
of
hypothyroidism is iodine deficiency, but
this is rarely seen in developed world
,where autoimmune hashimoto`s thyroiditis
is more common .
 THYROID DISEASE DURING
PREGNANCY

HYPOTHYROIDISM :
 women diagnosed with hypothyroidism
should continue full thyroid replacement
during pregnancy.
 THYROID DISEASE DURING
PREGNANCY

HYPOTHYROIDISM
 hypothyroidism is associated with
developmental delay and pregnancy loss.
Thank
YOU