Matineh Nirouei

Title : A pregnant woman with a history of SLE with PPROM and severe thrombocytopenia: A case study

Abstract:

Systemic Lupus erythematous (SLE) has a multisystem effect on patients. Lupus is more prevalent in women of reproductive ages. Pregnant women who have a history of SLE have higher rates of fetal demise, hypertensive disease, thromboembolism, fetal growth restriction (FGR), premature delivery, and neonatal death. Many of these complications can be attributed to SLE treatment more than to the disease itself.
In this study, we discussed a case of a pregnant woman with a history of lupus from 4 years ago and severe thrombocytopenia; who was referred to our hospital. A 41-year-old woman was referred to our hospital at 32 weeks by a rupture of the membrane. She had a history of lupus and she was in the remission phase. In clinical exams, we detected severe thrombocytopenia (8.0*10³   mm/dl). Her thrombocytopenia didn’t respond to prednisolone at first so we added Intra Venous Immunoglobulin (IVIG) to her treatment. After 2 days of hospitalization because of a decrease in fetal movement, increase in FHR (170-175), and non-reactive non-Stressed test (NST) the patient candidate for emergency cesarean (C/S) with low platelet count (20.2*10³   mm/dl) and general anesthesia. Because thrombocytopenia didn’t respond to prednisolone and IVIG and hard situation we used 5 units of Platelet before delivery. During surgery, we found placental abruption and post-partum hemorrhage so we fixed Bakri balloon and rectal misoprostol. After C/S she was admitted to the Intensive Care Unit (ICU) for 5 days for continuing her treatment.
The management of severe lupus during pregnancy is so difficult. High-dose corticosteroids and Azathioprine are the accepted medications available for the treatment of severe lupus during pregnancy. In this case, we had a very difficult situation because of severe thrombocytopenia and placental abruption, and post-partum hemorrhage. Managing this difficult situation would be a good experience for other specialists.

Audience Take Away:

• This study discusses the management of a pregnant woman with PPROM and a history of lupus. She was found to be severely thrombocytopenic and was unresponsive to prednisolone. During the caesarian section, placental abruption was found and post-partum hemorrhage ensued.
• In this case study we describe our different and complicated situations and how we managed her therefore, other physicians can use it for their complicated patients.

Biography:

Dr. Matineh Nirouei studied Medicine at the Alborz University, Iran, and graduated with an MD degree in 2021. She is a highly motivated and innovative Doctor of Medicine. She is passionate about learning new scientific skills and also enthusiast team player adept at providing leadership while also learning from fellow team members. She has experience in managing multiple projects simultaneously. She is an effective communicator and presenter that can conceptualize complex and rare diseases to audiences with varied expertise. She has published about 10 research articles in different journals.