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SYSTEMIC LUPUS ERYTHEMATOSUS: CAUSES, SYMPTOMS, AND
TREATMENT APPROACHES
Shermatova Zuhra Abduhamidovna
Tashkent Medical University
https://doi.org/10.5281/zenodo.16830037
Relevance.
Systemic lupus erythematosus (SLE) is a disease that predominantly affects
women of reproductive age whose fertility is not impaired. This has determined a long-standing
interest in the problem of pregnancy and childbirth in SLE. As early as 1955, JA Merrill [113] in
one of the first literature reviews "SLE and pregnancy" noted that fetal losses in SLE amount to
36%. Subsequent numerous studies confirmed the fact of the unfavorable effect of SLE on the
course of pregnancy, its maternal and perinatal outcomes. According to G. Burkett [52], the
frequency of spontaneous abortions in SLE is 50%, stillbirths - 35%, premature births - 25%,
and about 5% of infants suffer from intrauterine growth retardation. In recent decades,
improvement of SLE diagnostics, especially its low-manifest forms, early and adequate
treatment have improved the prognosis of the disease, increased the life expectancy of patients,
which in turn led to a revision of the problem of motherhood in women with SLE. PA Gatenby
[70], summarizing the data of later literature, noted some improvement in pregnancy outcomes
in SLE: the frequency of abortions on average decreased to 18%, intrauterine fetal death was
13%, premature birth - 20%. Despite a significant number of publications concerning
pregnancy in SLE, many issues in this problem still remain unresolved, controversial and
require further study. Thus, the influence of the activity and clinical and laboratory features of
SLE on the course and outcomes of gestation has not been sufficiently assessed . In addition, the
complexity of interpreting the detected clinical and serological changes is due to the fact that it
is not always possible to attribute them to the actual activity of SLE or to the physiological
manifestations of pregnancy and its complications. The issues of early diagnosis of perinatal
complications and adverse gestation outcomes in SLE have not been developed.
The aim of the work.
Reduction of pregnancy complications, perinatal morbidity and
mortality in women with SLE by identifying their risk factors and optimizing early diagnostics.
Research objectives.
1. To study clinical and laboratory features of pregnancy and
maternal and fetal outcomes in patients with SLE. 2. To study the effect of SLE activity on the
course of pregnancy and its outcomes.
Results of the study.
In patients with SLE, pregnancy ended in delivery of a viable child
in 86.7% of cases, pregnancy losses were 13.3%. All cases of adverse gestation outcomes were
observed in the third trimester of pregnancy or early neonatal period, which determines the
need to develop therapy for pregnant women with SLE in the late stages of gestation and active
obstetric and neonatal management tactics. Pregnancy in SLE was often complicated by the
threat of its termination (70%) and the development of FPN (56.7%), somewhat less often there
were early and late toxicosis (respectively 30 and 20%). SLE activity at the onset of pregnancy
was a determining factor in the course and outcomes of gestation : cases of perinatal losses
were significantly more common in the group of patients "active" in SLE (37.5%) than "inactive"
(4.5%) (2 = -2.31 p = 0.021); In patients with no or low activity of SLE, gestation more often
ended in term delivery (72.7% versus 37.5% in "active"), whereas in the case of active SLE,
premature delivery was more common (62.5% versus 27.3% in "inactive", 2 = 1.71, p = 0.082).
Children born to patients with "active" SLE had a significantly lower Apgar score than those
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with "inactive" SLE (2 = 2.43, p = 0.015), which correlated with STEP in the trimester (t = -0.35,
p = 0.02). There was a tendency for more frequent births of children with low birth weight for
gestational age in pregnant women with active SLE (62.5% versus 27.3% in the "inactive"
group, 2 = 0.63, p = 0.53). In 3 out of 30 pregnant women (10%) with active lupus nephritis
during gestation , in 2 cases the pregnancy ended with the birth of a viable infant, in one case -
with antenatal death of the fetus at 38-39 weeks . A history of nephritis and proteinuria less
than 0.5 g / day during gestation (in 76.7% of pregnant women) did not statistically
significantly affect the frequency of pregnancy complications, its maternal and neonatal
outcomes.
Conclusions.
Thus, the great theoretical interest and practical significance associated
with pregnancy planning in women with SLE, the use of modern studies on the control of
developing gestation, prompted us to undertake this study.
References:
Используемая литература:
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