Description
Systemic lupus erythematous (SLE) is an autoimmune disease with a strong reproductive age female predilection. Hence pregnancy remains a commonly encountered yet high risk situation, morbidity includes higher risk of disease flares, pre-eclampsia and other pregnancy-related complications. Lupus nephritis is a common complication of SLE and can lead to scarring and permanent damage to the kidneys and possibly end-stage renal disease (ESRD).
A 29-year-old primigravida with 30+4 week’s period of gestation, a referred case from a peripheral hospital, a known case of SLE(systemic lupus nephritis) with grade II lupus nephritis with chronic hypertension.
Patient was on follow up in AIIMS OPD from 18+5 weeks as a reffered case, already on prednisolone, azathioprine, HCQ and ecospirin. Patient started on lobetalol and nifidipine at 23 weeks of gestation and was managed in consultation with medicine , nephrology and rheumatology department on OPD basis.
Patient was admitted at 27+6weeks i/v/o superimposed preeclampsia patient managed conservatively in consultation with nephrology and cardiology department and discharged with escalated doses of lobetalol and nifidepine.
Patient presented to OPD at 30+4 weeks with Color Doppler study of the fetus, showing IUGR with Doppler changes. Repeat Doppler study at 30+5 weeks showed absent flow in the umbilical artery with brain sparing effect. Emergency LSCS was done and a preterm alive female baby of weight 850gm was delivered, baby cried spontaneously at birth and was shifted to NICU i/v/o prematurity and IUGR.The patient is admitted in PNC ward and is being managed in consultation with nephrology department, baby still in NICU and is doing well.
