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Pregnancy with SLE (Systemic Lupus Erythematosus)

Mrs ABC, G2L0 was admitted in La Femme on 29-06-2017 for elective LSCS under Dr Ritu Joshi. She was a known case of SLE (diagnosed in I pregnancy). During her first pregnancy at 22 weeks, the level II sonography showed foetal bradycardia with heart block (FHR 42 b/min). She was then thoroughly investigated and was diagnosed as SLE. She underwent induction of labour after in utero demise of foetus. She was started on medication for SLE.  Later, she consulted another immunologist who advised her to stop all medications and plan pregnancy. Patient got pregnant the second time and was started on low molecular weight heparin (LMWH) and aspirin. She was advised to start Tab HCQ but was not convinced. She was monitored closely with repeated sonographies. At 22 weeks, the fetal echo was also normal. At 24 weeks of gestation, sonography diagnosed fetal bradycardia of 97 b/min. She was again counselled and started on Tab HCQ and Tab Dexona, along with strict fetal monitoring. Fetal heart rate monitored every third day along with sonography every 10th day for fetal heart rate and amount of liquor and signs of FGR. The fetal heart rate maintained between 106-110 b/min. Decision for elective caesarean section was taken at 38 weeks pregnancy and Tab Ecosprim was withdrawn three days prior to date of surgery. LMWH was stopped 24 hours prior and Tab Dexona continued till date of surgery. LSCS was done on 29/05/2017 and she delivered a male child. Baby weight was 2.8 kgs and was monitored in nursery for heart beat for 2 days after which it stabilized. Paediatric cardiologist was consulted, echocardiography was normal. Patient was discharged with a healthy baby. Tab Dexona continued post operatively and was slowly withdrawn by tapering the dose.

Dr Ritu Joshi
MS (Gynaecology & Obstetrics)
Sr. Consultant,
Dept of Obstetrics and Gynaecology,
La Femme Jaipur

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