Author/Editor     Novak-Antolič, Živa; Ogrizek-Pelkič, Ksenija
Title     Vodenje nosečnic s sistemskimi vezivnimi boleznimi
Translated title     Pregnancy surveillance in patients with systemic connective tissue diseases
Type     članek
Source     Med Razgl
Vol. and No.     Letnik 42, št. Suppl 3
Publication year     2003
Volume     str. 71-82
Language     slo
Abstract     The diagnosis of systemic connective tissue disease (SCTD) is usually known before pregnancy; some patients, however, are first encountered when a severe complication occurs in pregnancy and the diagnosis of SCTD is made afterwards, sometimes years later. Most SCTD alter pregnancy outcomes; the severe perinatal complications being spontaneous and missed abortions,:intrauterine growth retardation, intrauterine fetal death, preeclampsia/eclampsia, (iatrogenous) preterm delivery, congenital heart block, infant morbidity and mortality. Spontaneous preterm delivery is often associated with congenital uterine malformations. The answer if systemic lupus erythematosus (SLE) worsens during pregnancy, compared to patients who are not pregnant, is not settled yet. With rheumatoid arthritis (RA), in majority of patients, there is improvement during pregnancy and relapse in the postpartum period. Antiphospholipid syndrome, hypertension, renal involvment or active disease at the time of conception all worsen maternal and fetal prognosis. The pregnant woman with SCTD should get the same advices and care as other pregnant women; to take folic acid after stopping contraception use. She is offered trisomy 21 screening tests (nuchal translucency and nasal bone measurement, PAPP-A and fbetaHCG estimation in the first and betaHCG, AFP and estriol estimation in the second trimester of pregnancy). Anticoagulant and antiaggregational prophylaxis and treatment is given when indicated, before, during and after pregnancy. When the mother has anti-Ro/SS-A and anti-La/SS-B, ultrasound examination of fetal heart is mandatory as well as prophylaxis and treatment of the existing child's condition. Alpha methyldopa is the antihypertensive of the first choice and should be given as soon in pregnancy as indicated. (Abstract truncated at 2000 characters).
Summary     Da ima bolnica sistemsko vezivno bolezen (SVTB), je navadno znano že pred nosečnostjo, včasih pa postavimo diagnozo SVTB ob hudem zapletu v nosečnosti ali šele veliko let pozneje. Večina SVTB spremeni izid nosečnosti; hudi zapleti so lahko spontani in zadržani splav, znotrajmaternični zastoj rasti, smrt ploda v maternici, preeklampsija/eklampsija (PE/E), (iatrogeni) prezgodnji porod, kongenitalni srčni blok, neonatalna obolevnost in umrljivost dojenčkov. Ob spontanem prezgodnjem porodu pogosto najdemo razvojno nepravilnost maternice. Odgovora na vprašanje, ali se sistemski eritematozni lupus (SLE) v nosečnosti poslabša, še ni. Pri večini bolnic z revmatoidnim artritisom (RA) pride do izboljšanja bolezni ter ponovitve bolezni po porodu. Slabši izid nosečnosti je pričakovati, kadar gre obenem za antifosfolipidni sindrom (APS), hipertenzijo, prizadetost ledvic ali aktivno bolezen ob zanositvi. Vodenje nosečnosti ter nadzor matere in ploda je treba prilagoditi; navedenim spoznanjem. Nosečnica s SVTB mora biti deležna enakih nasvetov in postopkov kot zdrava nosečnica. Nosečnost naj bo načrtovana, folno kislino naj jemlje od prenehanja uporabe kontracepcije do dvanajstega tedna nosečnosti. Prav tako nosečnici ponudimo presejalne teste za odkrivanje trisomije 21 (meritev nuhalne svetline, nosne kosti, dolocanje PAPP-A in fbetaHCG v prvem oziroma (betaHCG, AFP in estriola v drugem trimesečju) ter ultrazvočni pregled okrog 20. tedna za ugotavljanje normalne morfologije ploda. Pri nosečnicah s SVTB se posebej odločamo o antikoagulacijskem in protitrombocitnem preprečevanju in zdravljenju pred in med nosečnostjo ter po njej. (Izvleček skrajšan pri 2000 znakih).
Descriptors     PREGNANCY COMPLICATIONS
CONNECTIVE TISSUE DISEASES
FETAL GROWTH RETARDATION
PRE-ECLAMPSIA
FETAL DEATH
PREGNANCY
LABOR, PREMATURE