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Autoimmune Disorders In Pregnancy

Some Autoantibodies Produced in Patients with Systemic Lupus Erythematosus



Incidence (%)

Clinical Association





Anti-Ro (SS-a)

Anti-La (SS-B)











Multiple antibodies; repeat negative test makes lupus unlikely

Associated with nephritis and clinical activity

Specific for lupus

Polymyositis scleroderma, lupus, mixed connective-tissue disease

Sjögren syndrome, cutaneous lupus, neonatal lupus with heart block, ANA-negative lupus

Always with anti-Ro: Sjögren syndrome

Common in drug-induced lupus (95%)

Lupus anticoagulant and anticardiolipin a/w thrombosis, fetal loss, thrombocytopenia, valvular heart disease; false-positive test for syphilis


SLE and Pregnancy: Maternal and Perinatal Effects





Lupus flare

Preterm labor


Preterm delivery

Growth restriction


Neonatal lupus

  1. One-third of patients with SLE improve in pregnancy, one-third remain unchanged, and one-third worsen (flare up) during pregnancy.
  2. Flare can be life threatening and flares are associated with worse perinatal outcomes.

Indications to Identify Lupus Anticoagulant and Antiphospholipid Antibodies

  1. Recurrent pregnancy loss
  2. Unexplained second -or third-trimester loss
  3. Early-onset severe preeclampsia
  4. Venous or arterial thrombosis
  5. Unexplained fetal growth restriction
  6. Autoimmune or connective-tissue disease
  7. False-positive serological test for syphilis

Surgical Complications in Pregnancy

Fibroids in Pregnancy

  1. Effects of fibroids on pregnancy:
    1. Recurrent abortions
    2. Impacted posterior fibroid can lead to retroverted gravid uterus and urinary retention
    3. Malpresentations
    4. Preterm labor
    5. IUGR
    6. Prolonged labor I obstructed labor
    7. Cervical dystocia
    8. Abruption
    9. Atonic PPH
    10. Increased risk of obstetric hysterectomy
  2. Effects of pregnancy on fibroids:
    1. Red degeneration
    2. Increase in size
    3. Torsion

Red Degeneration (Also Known as Carneous Degeneration)

  1. Occurs because fibroid overgrows its blood supply (micro necro thrombosis)
  2. Most commonly occurs in second trimester of pregnancy followed by in the puerperium
  3. Cut section: raw beefy appearance, fishy odor
  4. Patient presents with acute abdomen, vomiting, fever, and leukocytosis
  5. D/D: acute appendicitis, pyelonephritis, and abruption
  6. Management:
    1. Always conservative management (never surgery)
    2. Hospitalization
    3. Bed rest
    4. Analgesics
    5. IV fluids
    6. IV antibiotics (SOS)

Ovarian Cysts in Pregnancy

  1. MC ovarian tumor in pregnancy is dermoid cyst followed by serous cyst adenoma
  2. MC ovarian tumor to undergo torsion = dermoid cyst
  3. Torsion is most likely to occur at the end of first trimester and /or in puerperium

Pregnancy Luteoma


In 1963, Sternberg described a solid ovarian tumor that developed during pregnancy and was composed of large acidophilic luteinized cells. These represented an exaggerated luteinization reaction of the normal ovary. These so-called luteomas of pregnancy are variable in size, ranging from microscopic to over 20 cm in diameter. Although luteomas regress after delivery, they may recur in subsequent pregnancies. Pregnancy luteomas may result in maternal virilization, but usually the female fetus is not affected.


Theca-Lutein Cysts


These benign ovarian lesions result from exaggeration by physiological follicle stimulation, which is termed hyperreaction luteinalis. The reaction is associated with markedly elevated serum levels of hCG.


Acute Appendicitis

  1. There is no increase in incidence in pregnancy, but mortality is higher.
  2. During pregnancy the cecum and appendix are displaced upward and to the right. Therefore, classical right iliac fossa pain may not be present.
  3. Rebound tenderness is less obvious.
  4. Therefore, diagnosis is delayed and perforation rates are higher.
  5. Treatment of acute appendicitis in pregnancy = emergency surgery (appendectomy irrespective of weeks of gestation).

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