318. IMPROVED OUTCOMES IN HIGH-RISK LUPUS PREGNANCIES: USEFULNESS OF A PROTOCOL-BASED MULTIDISCIPLINARY APPROACH IN KERALA, INDIA

Abstract

Background: In patients with SLE who had previous adverse obstetric outcome(s) the risk of an adverse outcome in subsequent pregnancy rises. The primary objective of this study was to assess the impact of a protocol based multidisciplinary care on pregnancy outcome(s) in a prospective cohort of patients with SLE who had previous adverse obstetric outcome(s). Methods: Between March 2010 and March 2016 all patients with SLE with previous at least one adverse obstetric (either maternal or foetal) outcome desirous of having more children were prospectively enrolled. All patients had in-depth preconception counselling and were prospectively followed throughout the pregnancy as per the protocol with multidisciplinary team input. Briefly the protocol comprised of pre natal counselling, pre and post natal drug and disease status review, risk stratification, periodic ante-natal visits for the monitoring of pregnancy (including with obstetric ultrasounds) and disease, 2D echocardiogram at weeks 18 and 32 if Ro/La were positive and post natal contraception advice. Therapeutic changes were made as necessary at each visit. Results: Fifty-three patients (age mean±SD years; 28±3) were enrolled. Previous poor obstetric outcomes were: miscarriage(s) in 30, MTP in 9, preterm labour with IUGR in 9, intrauterine death, still birth in 2 each and pre ecalapmsia in 1. Nine patients had secondary APS and 14 had both or either Ro/La positive. Nine had lupus nephritis (LN); more than 6months ago in all. There were 44 (85%) live births (10 LBW; instrumentation or caesarean section in 28). Eight patients had miscarriages. One decided against becoming pregnant after the initial counselling. Sixteen patients (30%) had lupus flare (9 mild, 5 moderate and 2 severe based on SLEPDAI).