Practical management of the pregnant patient with rheumatic disease

Rheumatic and autoimmune diseases are often present in women during the childbearing years and as such, correct management of pregnancy throughout its course is of significance to all those affected. Previously women with systemic rheumatic diseases were counselled against pregnancy as the majority of medications carried potential or perceived teratogenic risk. But in recent years new therapies have emerged that have advanced treatment. Patients have experienced significant improvements in physical function, quality of life, and reduced damage accrual. As a result, an expanded cadre of health care providers now need to be able to manage pregnancy in women with underlying rheumatic disease, both in acute or chronic settings.

Practical Management of the Pregnant Patient with Rheumatic Disease is a quick-access guide of the most up-to-date understanding of the interplay between pregnancy and rheumatic diseases and principles of management before, during and after pregnancy assisting in decision making regarding treatment of women with autoimmune diseases.

This collection of 70 cases covers pregnancy counseling, the management of disease flares, thromboembolic disease, the management of patients with end organ disease, advice on medications, obstetric complications, infections and the management of rare diseases in women with rheumatic diseases before and during pregnancy and post-partum.

The handbook provides concise recommendations for all providers who may encounter women of child-bearing age including rheumatologists, gynaecologists, paediatricians, primary care providers and health professionals dealing with pre-conceptional and pregnant women with rheumatic diseases.

Contents

Section One: Counselling
1:Important points of pre-pregnancy counselling, Monika Østensen
Section Two: Patients with pre-pregnancy complications
2.1:Thrombotic Complications in pregnant patients with rheumatic disease, Andrew James Doyle and Beverley Jane Hunt
2.2:Prevention of postpartum venous thromboembolism (VTE), Roseann O'Doherty and Fionnuala Ní Ainle
2.3:Pulmonary Arterial Hypertension, Eliza Chakravarty
2.4:Advanced renal disease / renal impairment, Hannah Blakey and Kate Bramham
2.5:Antibodies as risk factors for adverse maternal and fetal outcomes, Massimo Radin, Karen Schreiber, and Savino Sciascia
Section Three: Adjustment of therapy before/during pregnancy and lactation
3.1:Disease modifying drugs, biological drugs and concomitant medications before/during pregnancy and lactation, Monika Østensen and Ian Giles
3.2:Managing a patient exposed to a teratogenic drug at different stages of pregnancy, Christof Schaefer
Section Four: Infection during pregnancy
4:Infection in a pregnant patient on immunosuppressive treatment, Maria Rhona G. Bergantin and Sandra V. Navarra
Section Five: Organ specific flares during pregnancy
5:Managing Organ Specific Flares, Bonnie L. Bermas and Eliza Chakravarty
Section Six: Obstetric complications in women with autoimmune diseases
6:Pregnancy and Obstetric Complications in Women with Autoimmune Diseases, D. Ware Branch
Section Seven: Vaccination before or during pregnancy
7:Vaccination before or during pregnancy, Cara D Varley and Kevin L Winthrop
Section Eight: Rare diseases in pregnancy
8.1:SLE, Karen Schreiber and Monika Ostensen
8.2:Systemic lupus erythematosus and the risk of cardiovascular disease, Karen Schreiber and Soeren Jacobsen
8.3:3 Antiphospholipid syndrome, Karen Schreiber and Savino Sciascia
8.4:Vasculitis in Pregnancy, Megan Clowse and Jon Golenbiewski
8.5:Systemic sclerosis, Eliza Chakravarty
8.6:Myositis and Pregnancy, Muhammed Shipa and David Isenberg
8.7:Ankylosing spondylitis in pregnancy, Monika Østensen