Analysis Of Clinical Characteristics And Pregnancy Outcomes In Systemic Lupus Erythematosus With Pregnancy

Research Objective:To investigate the clinical manifestations,laboratory examination results and drug use of disease activity and inactivity in systemic lupus erythematosus(SLE)with pregnancy.To explore the clinical features of disease activity and the influence of this disease on pregnancy outcomes.Strengthen early recognition of disease activity during pregnancy,to guide clinical practice and improve pregnancy outcomes.Research Methods:A total of 72 pregnant women with SLE were terminated pregnancy at Yangzhou Subei Hospital from August 2012 to July 2019,their clinical manifestations,immune indexes,medication and pregnancy complications were analyzed retrospectively.According to the SLE disease activity index(SLEDAI),they were divided into 33 cases in inactive group(?4 points)and 39 cases in active group(?5 points)Research Results:1?The general situation of the two groups of patients:Differences were no statistically significant in age,number of pregnancies,and duration of disease between the two groups(P>0.05).The SLEDAI score of the active group during pregnancy was higher than that of the inactive group.The follow-up in rheumatology and immunology department was more frequent than that in the active group.Differences were statistically significant(P<0.05).2?Activity status and clinical manifestations of SLE patients during pregnancy:32 cases(82.05%)with disease activity were in the second and third trimester.The disease activity in this stage was more obvious.Difference was no statistically significant in the activity level of SLE among different pregnancy periods(P>0.05).The main manifestations of disease activity in the first trimester are rash and changes in the blood system,and the manifestations of multi-system involvement in the second and third trimester,especially kidney disease.Rash and lupus nephritis were more common in the active group than in the inactive group.Differences were statistically significant(P<0.05).3?Comparison of immunological indexes and treatment between the two groups:The titer of anti-ds-DNA antibody in the active group was significantly higher than that in the inactive group,and the reduction of complement C3 and C4 in the active group was more common than that in the inactive group.Differences were statistically significant(P<0.05).The proportion of hydroxychloroquine use in the inactive group was significantly higher than that in the active group.Difference was statistically significant(P<0.05)4?Effect of SLE disease activity on mother and infant:The fetal loss rate in the active group was significantly higher than that in the inactive group,the preterm delivery rate was obviously increased,and the live birth rate was decreased.Differences were statistically significant(P<0.05).The average gestational age of the fetus in the active group was significantly smaller than that of the inactive group,and the fetal birth weight was significantly lighter than that of the inactive group.Differences were statistically significant(P<0.05).Differences were no significantly significant in hypertension,oligohydramnios,lung damage,heart damage,postpartum hemorrhage,and maternal death between the two groups(P>0.05).Differences were statistically significant in the incidence of preeclampsia,premature rupture of membranes,and renal damage between the two groups(P<0.05)5?Comparison of pregnancy termination methods:Among the 56 cases of successful pregnancy,39 were cesarean section(69.64%)and 17 were vaginal delivery(30.36%)Difference was no statistically significant between the two groups in delivery methods(P>0.05).Among them,complications caused by SLE activities resulted in 17 cases of cesarean section(43.59%).Research Conclusion:1?The disease activity of SLE during pregnancy is concentrated in the second and third trimesters,but there is no difference in the level of disease activity during pregnancy.The duration of hospitalization for pregnant women with disease activity is significantly prolonged.The number of follow-up visits to rheumatology and immunology department during pregnancy is less.2?The main manifestations of disease activity in first trimester are rashes and changes in the blood system,and the multi-system involvement is more common in the second and third trimesters.The main manifestations of disease activity in pregnancy are rashes and lupus nephritis,and the anti-ds-DNA antibody titer increased and complement C3 And C4 decreased,Disease activities should be found in time according to clinical manifestations and laboratory examination results,and medication should be appropriately adjusted to control the deterioration of the disease.Pre-pregnancy,pregnancy and postpartum are important for control of the disease,and strengthen pregnancy management to obtain a good pregnancy outcome.3?Patients with SLE should choose an appropriate time to pregnancy,conception during disease remission is of great significance to improve the pregnancy outcomes.Pregnancy loss and premature birth rate during disease activity are significantly higher than those of inactive patients.Disease activity can easily involve important organ lesions.So it can predict adverse pregnancy outcomes and severe maternal complications.4?There is no obvious difference between pregnant women who choose cesarean section or vaginal delivery.There is no indication of obstetric cesarean section,vaginal trial delivery should be considered in principle.When the deterioration of the disease condition can't be controlled,regardless of whether the fetus is mature,it should be timely terminate the pregnancy by cesarean section.The rate of cesarean section can be reduced by controlling the disease during pregnancy,and reducing the incidence of maternal and fetal complications.