Pregnancy and vasculitis, case series
In patients with positive Antineutrophil Cytoplasmic Antibody (ANCA) vasculitis, both maternal and fetal outcomes may be compromised by disease activity and medication used; however, being pathologies of low prevalence, there are few descriptions in the literature. To reduce these...
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| Autores principales: | , , , , , , , |
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| Formato: | Artículo revista |
| Lenguaje: | Español |
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Universidad Nacional Cba. Facultad de Ciencias Médicas. Secretaria de Ciencia y Tecnología
2019
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| Acceso en línea: | https://revistas.unc.edu.ar/index.php/med/article/view/26173 |
| Aporte de: |
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I10-R10-article-26173 |
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Universidad Nacional de Córdoba |
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Revistas de la UNC |
| language |
Español |
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Artículo revista |
| topic |
ANCA pregnancy complications vasculitis ANCA embarazo complicaciones |
| spellingShingle |
ANCA pregnancy complications vasculitis ANCA embarazo complicaciones Alonso, CG Tissera, YS Quaglia, MI Savio, V Albiero, JA Maldini, CS Gobbi, CA Alba, P Pregnancy and vasculitis, case series |
| topic_facet |
ANCA pregnancy complications vasculitis ANCA embarazo complicaciones |
| author |
Alonso, CG Tissera, YS Quaglia, MI Savio, V Albiero, JA Maldini, CS Gobbi, CA Alba, P |
| author_facet |
Alonso, CG Tissera, YS Quaglia, MI Savio, V Albiero, JA Maldini, CS Gobbi, CA Alba, P |
| author_sort |
Alonso, CG |
| title |
Pregnancy and vasculitis, case series |
| title_short |
Pregnancy and vasculitis, case series |
| title_full |
Pregnancy and vasculitis, case series |
| title_fullStr |
Pregnancy and vasculitis, case series |
| title_full_unstemmed |
Pregnancy and vasculitis, case series |
| title_sort |
pregnancy and vasculitis, case series |
| description |
In patients with positive Antineutrophil Cytoplasmic Antibody (ANCA) vasculitis, both maternal and fetal outcomes may be compromised by disease activity and medication used; however, being pathologies of low prevalence, there are few descriptions in the literature. To reduce these risks, pregnancies should be planned after achieving sustained remission or low disease activity for at least 6 months.
The aim of this investigation was to describe maternal and fetal pregnancy outcomes in patients with vasculitis.
Case 1: A 25 years old woman with granulomatosis with polyangiitis, 5 years of evolution, upper airway involvement, retro orbital pseudotumor, lumbar back tumor of giant cells, pericarditis, pulmonary nodules and diabetes insipidus. She had 2 unplanned pregnancies after the diagnosis of vasculitis. She required cyclophosphamide 6 months before to pregnancy n ° 2, during which she was treated with Azathioprine. Cesarean section scheduled at 37 weeks (W) for oligoamnios, appropriate for gestational age (AGA) neonate. Pregnancy n ° 3 without previous activation, with equal treatment, without maternal or fetal complications, cesarean section due to previous cesarean section in W38, AGA neonate. Case 2: A 28 years old woman with Microscopic Polyangiitis (ANCA P +, MPO +) at 21 years old, pulmonary and renal involvement. It required Cyclophosphamide, Azathioprine and Rituximab. Rituximab suspended for family planning, changing to Azathioprine. W14: elevation of proteinuria with normal renal function, ANCA negative, normal Doppler at W12. W20 due to persistent proteinuria, the dose of corticosteroid is increased. Pulmonary maturation at W31 due to edema and increased proteinuria with preserved renal function and hypertension, treated with corticosteroids, azathioprine, antihypertensives and magnesium sulfate. Complications: steroid versus gestational diabetes, cholestasis. W34 due to renal failure, cesarean section is performed, AGA neonate. She recovery her renal function in the puerperium.
Although pregnancies in patients with vasculitis are high risk, in our small series those who attended with disease activity had complications, however maternal and fetal outcomes were favorable. Multidisciplinary follow-up by the rheumatologist and obstetrician is essential to achieve maternal fetal well-being. |
| publisher |
Universidad Nacional Cba. Facultad de Ciencias Médicas. Secretaria de Ciencia y Tecnología |
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2019 |
| url |
https://revistas.unc.edu.ar/index.php/med/article/view/26173 |
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I10-R10-article-261732019-11-11T21:18:27Z Pregnancy and vasculitis, case series Embarazo y vasculitis, serie de casos Alonso, CG Tissera, YS Quaglia, MI Savio, V Albiero, JA Maldini, CS Gobbi, CA Alba, P ANCA pregnancy complications vasculitis ANCA embarazo complicaciones In patients with positive Antineutrophil Cytoplasmic Antibody (ANCA) vasculitis, both maternal and fetal outcomes may be compromised by disease activity and medication used; however, being pathologies of low prevalence, there are few descriptions in the literature. To reduce these risks, pregnancies should be planned after achieving sustained remission or low disease activity for at least 6 months. The aim of this investigation was to describe maternal and fetal pregnancy outcomes in patients with vasculitis. Case 1: A 25 years old woman with granulomatosis with polyangiitis, 5 years of evolution, upper airway involvement, retro orbital pseudotumor, lumbar back tumor of giant cells, pericarditis, pulmonary nodules and diabetes insipidus. She had 2 unplanned pregnancies after the diagnosis of vasculitis. She required cyclophosphamide 6 months before to pregnancy n ° 2, during which she was treated with Azathioprine. Cesarean section scheduled at 37 weeks (W) for oligoamnios, appropriate for gestational age (AGA) neonate. Pregnancy n ° 3 without previous activation, with equal treatment, without maternal or fetal complications, cesarean section due to previous cesarean section in W38, AGA neonate. Case 2: A 28 years old woman with Microscopic Polyangiitis (ANCA P +, MPO +) at 21 years old, pulmonary and renal involvement. It required Cyclophosphamide, Azathioprine and Rituximab. Rituximab suspended for family planning, changing to Azathioprine. W14: elevation of proteinuria with normal renal function, ANCA negative, normal Doppler at W12. W20 due to persistent proteinuria, the dose of corticosteroid is increased. Pulmonary maturation at W31 due to edema and increased proteinuria with preserved renal function and hypertension, treated with corticosteroids, azathioprine, antihypertensives and magnesium sulfate. Complications: steroid versus gestational diabetes, cholestasis. W34 due to renal failure, cesarean section is performed, AGA neonate. She recovery her renal function in the puerperium. Although pregnancies in patients with vasculitis are high risk, in our small series those who attended with disease activity had complications, however maternal and fetal outcomes were favorable. Multidisciplinary follow-up by the rheumatologist and obstetrician is essential to achieve maternal fetal well-being. En las pacientes con vasculitis anticuerpos anticitoplasma de neutrófilos positivos (ANCA), tanto los resultados maternos como los fetales podrìan estar comprometidos por la actividad de la enfermedad y por la medicaciòn utilizada; sin embargo al ser patologìas de baja prevalencia, exiten pocas descripciones en la literatura. Para disminuir estos riesgos los embarazos deben planificarse luego de lograr la remisión sostenida o baja actividad de las enfermedad por al menos 6 meses. El objetivo del trabajo fue describir resultados maternos y fetales de embarazos en pacientes con vasculitis . Caso 1: Mujer de 25 años tercigesta con granulomatosis con poliangeitis, 5 años de evolución, compromiso de vía aérea superior, pseudotumor retroorbitario, tumor dorso lumbar de células gigantes, pericarditis, nódulos pulmonares y diabetes insípida. Cursó 2 embarazos no planificados posteriores al diagnóstico de vasculitis. Requirió ciclofosfamida 6 meses previo a gesta n°2, durante la cual se trató con Azatioprina. Cesárea programada a las 37 semanas (S) por oligoamnios, neonato adecuado para la edad gestacional (AEG). Gesta n°3 sin activación previa, con igual tratamiento, sin complicaciones maternas ni fetales, cesárea por césarea previa en S38, AEG. Caso 2: Mujer de 28 años, con Poliangeítis Microscópica (ANCA P+, MPO+) a los 21 años, compromiso pulmonar y renal. Requirió Ciclofosfamida, Azatioprina y Rituximab. Suspendió Rituximab por planificación familiar, rotando a Azatioprina. S14: elevación de proteinuria con función renal normal, ANCA negativo, Doppler a la S12 normal. S20 persiste con proteinuria por lo que se aumenta dosis de corticoide. Maduración pulmonar a la S31 por edemas y aumento de proteinuria con función renal conservada e hipertensión, tratada con corticoides, Azatioprina, antihipertensivos y sulfato de magnesio. Complicaciones: diabetes esteroidea versus gestacional, colestasis. S34 por falla renal se realiza cesárea, neonato AEG. Recuperación de función renal en el puerperio. A pesar de que los embarazos en pacientes con vasculitis son de alto riesgo, en nuestra pequeña serie aquellos que cursaron con actividad de la enfermedad tuvieron complicaciones, sin embargo los resultados maternos y fetales fueron favorables. El seguimiento multidisciplinario por el reumatólogo y el obstetra es esencial para lograr el bienestar materno fetal. Universidad Nacional Cba. Facultad de Ciencias Médicas. Secretaria de Ciencia y Tecnología 2019-10-31 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion application/pdf https://revistas.unc.edu.ar/index.php/med/article/view/26173 Revista de la Facultad de Ciencias Médicas de Córdoba.; 2019: Suplemento JIC XX Revista de la Facultad de Ciencias Médicas de Córdoba; 2019: Suplemento JIC XX Revista da Faculdade de Ciências Médicas de Córdoba; 2019: Suplemento JIC XX 1853-0605 0014-6722 spa https://revistas.unc.edu.ar/index.php/med/article/view/26173/27990 Derechos de autor 2019 Universidad Nacional de Córdoba |