自己免疫疾患 (<教育講演>合併症妊娠における胎児・新生児管理)

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Autoimmune disorders such as SLE and ITP occur more commonly in young women and are the most common complications in pregnancy. There is considerable contorversy concerning the risk to the mother and fetus, and the optimal prepartum management for mininizing that risk. 1. SLE is an autoimmune disorder in which IgG antibodies such as anti dsDNA-IgG, anticardiolipin IgG, and anti SS-A/Ro IgG are produced. Lupus nephropathy accompanied by diminished serum complement (CH50) and a rise in antibodies against dsDNA is a frequent clinical problem during pregnancy, which represents the adverse effect of hypertension or superimposed toxemia and causes fetal death or intrauterine fetal growth retardation. Habitual abortion or fetal death is common in a case with high anticardiolipin IgG titre. Anti SS-A antibodies are often found in the infants of antibody-positive mothers, and the deposition of antibodies in the perinodal region cause congenital heart block. IgG or immune complexes crossing the placenta directly injures the cardiac conduction system. In these cases which have high titre of autoimmune antibodies, corticosteroid therapy should be started. 2. Management of ITP in pregnancy involves the consideration of three issues : 1) treatment of maternal thrombocytopenia, 2) prediction of fetal thrombocytopenia, 3) obstetrical management. ITP increases the risk for postpartum bleeding of sufficient severity to require blood transfusion. In most of these cases, maternal platelet counts are found to be less than 30,000/mm^3. Women who have symptomatic severe steroid-unresponsive ITP may benefit from intravenous IgG(IvIgG) given as elective treatment. The assay of maternal PAIgG or serum antiplatelet antibody level do not reliably predict neonatal thrombocytopenia. Decisions on the delivery modality based upon these values may be in error. Recently the pericutaneous umblical blood sampling (PUBS) has been used in late pregnancy to identify those fetuses who are thrombocytopenic and at risk for intrapartum intracranial hemorrhage. In cases where the fetal platelet count is less than 50,000/mm^3, Cesarean section or 400mg/kg/day×5 days, or 1g/kg/day×1 day of IvIgG before the onset of labor has proven beneficial. If the platelet count obtained by PUBS is greater than 50,000/mm^3, induction of labor and vaginol delivery may be attempted.
社団法人日本産科婦人科学会の論文
1990-08-01

自己免疫疾患 (<教育講演>合併症妊娠における胎児・新生児管理)

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