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Section of Obstetrics & Gynacology Mean percentile ± s.d. 100 _ 90

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Group 2 Asthma

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Fig 2 Mean birth weight of infants delivered to patients with asthma and patients with no respiratory disease REFERENCES Committee on Rating and Mental and Physical Impairment (1965) Journal ofAmerican Medical Association 194, 919 Sims C D, Chamberlain G V P & de Swiet M (1976) British Journal of Obstetrics and Gynacology 83, 434 Thomson A M, Billewlcz W Z & Hytten F E (1968) Journal of Obstetrics and Gynacology of the British Commonwealth 75, 903

Dr R R Grigor, Mr P C Shervington, Dr G R V Hughes & Mr D F Hawkins (Department of Medicine, Royal Postgraduate Medical School and Institute of Obstetrics

and Gynacology, Hammersmith Hospital, Du Cane Road, London W12 OHS) Outcome of Prepancy in Systemic Lupus Erythematosus

baby, while 18 (25 %) ended in abortion or stillbirth. Previous studies have shown a similar high incidence of fetal deaths (Estes & Larson 1965, Fraga et al. 1974). It is suggested that 'preclinical' disease may be present in many of these patients. Screening of patients, particularly Negroes, with recurrent abortions, may reveal previously unsuspected SLE. Sixty-four pregnancies occurred in 30 patients after the onset of clinical disease. Of these, 32 resulted in a live baby, while 32 (46%) ended in either spontaneous early abortion (23 pregnancies), therapeutic abortion (7) or stillbirth (2). Of the 44 women 39 produced at least one live baby. The outcome of each pregnancy did not correlate with specific maternal organ involvement. In particular, 15 patients had definite histological and/or biochemical and serological evidence of lupus nephritis, although none had seriously impaired renal function. The outcome of the 35 pregnancies in these patients was comparable with those in patients without renal involvement. No obvious progression of renal or any other organ dysfunction appeared to result from pregnancy. The administration of corticosteroids to control severe disease activity was continued or begun during the gestation period in 33 pregnancies. There was no significant difference in the early abortion rate compared with pregnancies not treated with steroids, but 12 of the 16 live babies in this group were delivered prematurely, before the 38th week. In the 16 successful pregnancies not receiving steroids, there were only 3 premature deliveries but more of these babies were small for dates (see Fig 1) even though these were likely to be patients less severely affected by SLE. Premature delivery would appear to correlate with increased maternal disease activity (Estes & Larson 1965,

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/ < t

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An accurate obstetric history has been obtained from 44 parous women with systemic lupus erythematosus (SLE), who have attended the Departments of Medicine and Obstetrics at Hammersmith Hospital over the last ten years. Twenty-four of the women were Caucasian, 15 Negro and 5 Asian. A total of 137 pregnancies was recorded. Seventy-three pregnancies occurred in 30 patients before the onset of the first clinical manifestations of SLE. Of these, 55 resulted in a live

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Fig 1 High incidence ofpremature delivery in corticosteroid-treated pregnancies. Dysmaturity of term babies seen often when no corticosteroids given in pregnancy. * Corticosteroids during pregnancy. 0 No corticosteroids

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Proc. roy. Soc. Med. Volume 70 February 1977

Zurier 1975), rather than corticosteroid administration, as the incidence of prematurity in groups of patients with other chronic diseases requiring corticosteroids is only marginally increased (Schatz et al. 1975). Corticosteroids may assist growth of the fetus in utero. Exacerbations of disease activity occurred in 19 pregnancies, most commonly during the puerperium, but were controlled with increased doses of steroids in each case, and did not appear to affect the outcome of the pregnancy. Delivery was by Cxsarean section in 7 cases for well recognized obstetric indications. There was one neonatal death, due to respiratory distress. No congenital abnormalities were noted. These data support the view that SLE, even when mild renal disease is present, is not a contraindication to pregnancy (Fraga 1974, Zurier 1975, Dubois 1974).

Correction In Table 1 of the paper 'Betamethazone Induction of Labour' by Professor Ian Craft et al. (November Proceedings, p 827) the second item in the column headed 'Betamethazone' should read 'Term + 3 days'.

REFERENCES Dubois E L (1974) In: Lupus Erythematosus. Ed. E L Dubois. University of Southern California Press, Los Angeles; p 612 Estes D & Larson D L (1965) Clinical Obstetrics and Gynacology 8, 307-321 Fraga A, Mintz G, Orozco J & Orozco J H (1974) Journal of Rheumatology 1, 293-298 Schatz M, Patterson R, Zeitz S, O'Rourke J & Melam H (1975) Journal of the American Medical Association 233, 804-807 Zurier R (1975) Clinics in Rheumatic Diseases 1, 613-620

The following paper was also read: Idiopathic Thrombocytopenia in Pregnancy Mr David Sykes (Royal Devon and Exeter Hospital, Exeter)

Outcome of pregnancy in systemic lupus erythematosus.

99 Section of Obstetrics & Gynacology Mean percentile ± s.d. 100 _ 90 70 60- 50 - 40- 3020 10 0 Group I Group 2 Asthma - Control Fig 2 Mea...
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