Abstract

The immune system has got a remarkable ability to protect self from non self. An abnormality in this behavior results in a state called autoimmunity and the resultant diseases are called autoimmune diseases. Around 70% of the patients with autoimmune diseases are females. The common autoimmune diseases encountered in clinical practice are: Systemic Lupus Erythematosus, Immune Thrombocytopenic purpura, Type 1 Diabetes Mellitus, Myasthenia Gravis, etc. It is also seen that adverse pregnancy outcomes like abortions, spontaneous intrauterine deaths, abruption, preterm labour, IUGR, gestational hypertension etc. are more common in this group of patients. Many of these diseases can result in good obstetric outcome in presence of a multidisciplinary approach and good antenatal care. In this study the fetal and maternal complications encountered in patients with autoimmune diseases are studied. This, being a descriptive study, a complete understanding of the disease process may not be obtained. According to the yearly statistics in our hospital, in the last five years, there have been around 15- 20 cases of SLE, APLA and ITP, fewer cases of Type Diabetes Mellitus and Myasthenia Gravis. My study would be to summarize the fetal and maternal outcomes in these diseases and to draw possible conclusions. The diseases taken for study are Systemic Lupus Erythematosus, Primary Antiphospholipid Antibody Syndrome, Immune Thrombocytopenic Purpura and Type 1 Diabetes Mellitus.

Objectives

Primary Objective                                                                   

• To study the fetomatemal outcome of autoimmune diseases in pregnancy in a tertiary care centre. 1

Secondary Objective

• To find out the association of autoimmune diseases with various adverse pregnancy outcomes in the study group.
• To identify the various fetal complications of autoimmune diseases in the study group

Materials and Methods: This was a descriptive study conducted in Department of obstetrics and gynaecology, Sree Avittom Thirunal Hospital (SATH), Medical Colleg, Thiruvananthapuram from January 2012 to November 2012 Study Population included patients with already diagnosed cases of Autoimmune Diseases registered in Sree Avittom Thirunal Hospital, Thiruvananthapuram which is a tertiary care centre, are taken for the study.

Conclusion:  In the present study, 44.4% of the patient had SLE , 25% of the patients had APLA and 19.4% had ITP. In the present study about most of them were multigravidas. Among these multigravidas, about 71.4% had previous history of abortions and 42.8% had previous history of more than 2 abortions. Among the 16 patients of SLE 4 patients (25%) had previous history of two or more abortions. Out of the 36 patients in the study, only 12 patients (33.4%) had history of previous pregnancy reaching period of viability. Out of these 33.33% were SLE patients. Out of the 28 multigravidas under study only 5 patients (17.8%) had a previous successful birth outcome. It was observed that 41.7% had to be treated with steroid alone, 27.8% needed heparin and 11.1 % needed both. In SLE patients, 62.5% were on steroid alone and 25% of them were on both steroid and heparin. Out of those taking both steroid and heparin, 1 had secondary APLA. The group of drugs most commonly given to pregnant women with SLE is the glucocorticoid preparations, both as maintenance therapy. Among the patients who were given heparin alone, 80% were patients of primary APLA. Of the 36 patients studied, 11.1% of the patients developed thrombosis. Of them all were patients of SLE, of which one case of maternal death due to intracranial thrombosis was reported. This reflects the devastating effect of the disease and also the maternal mortality due to vascular thrombosis. Among the two cases of intrauterine death, one had primary APLA for2years duration and the other had uncontrolled diabetes. Hence diabetes should be strictly controlled during pregnancy. Out of the 36 patients, 27.8% had preterm deliveries and 16.7% had abortions. Out of abortions, 3 (50%) patients had SLE and 3 (50%) had APLA. Among the abortions 66.7% were second trimester abortions and 50% of them had SLE. This shows that abortion after appearance of cardiac activity occurred more with APLA and preterm births occurred more with SLE. Around 56.7% of the patients needed caesarean sections , the patients being the high risk group the incidence of operative delivery is more in them.53.3% of the babies had low birth weight and 50% of their mothers had SLE, showing that the incidence of intrauterine growth restriction and small for gestational babies is more in patients with autoimmune diseases. The important take home message is that autoimmune diseases are very commonly associated with complications like pretem deliveries, abortions, GHTN, intrauterine deaths. Hence they require good counseling and antenatal care an multidisciplinary approach in a tertiary centre.