[Obstetrical anesthesia of patients with disseminated lupus erythematosus]

Abstract

The anaesthetic management of pregnant women who suffered from systemic lupus erythematosus (SLE) was reviewed retrospectively. During the ten-year period studied, there were nineteen pregnancies in eighteen women (mean age 27 years) who had either SLE or an isolated lupus type anticoagulant (LAF). Four pregnancies were stopped before the third trimester, two spontaneously, and the other two because of the mother's condition. Of the fifteen remaining pregnancies, eight children were born with a weight less than 2,500 g. One child, birth weight 750 g, died after three days. None of the fourteen living children had neonatal lupus. Six epidural and twelve general anaesthetics were carried out for four abortions, nine Caesarian sections, and five deliveries. Epidural anaesthesia was often contraindicated by neurological and haemostatic complications of the SLE: recent meningitis, thrombocytopaenia, prolonged bleeding, anticoagulant therapy. In fact, management of SLE patients required extensive preanaesthetic clinical and paraclinical assessment, as all the systems may be involved in this condition; moreover, it may worsen during pregnancy (seven times in this series). The most frequent complications were cardiovascular, renal, and haematological. Possible intubation difficulties must also be looked for. A LAF was associated with a great number of venous thromboses. An isolated LAF does not contraindicate epidural anaesthesia, as long as there is no associated haemostatic defect, such as a thrombocytopaenia. Furthermore, the patient should not have had prolonged episodes of unexplained bleeding, or require anticoagulants. In the present series, epidural anaesthesia was contraindicated in three of the four patients with LAF. Finally, prevention of thromboembolism, postoperative infection and adrenal failure (in those patients with long-term steroid therapy) must be carried out.