LAUSR

Rheumatic diseases occur among women of childbearing age, adverse events during pregnancy in rheumatic diseases have been frequently reported. Mexico has one of the largest prevalence of cesarean section in women which negatively impacts the product.The objective of this study is to describe the frequency of cesarean section in women with autoimmune rheumatic diseases compared to a control group.We conducted a cross-sectional and retrospective study in patients from the pregnancy and rheumatic diseases clinic, and the Obstetrics department form the University Hospital “Dr. José E. González” in Northeast Mexico. Women with autoimmune rheumatic diseases that gave birth between August 2017 to December 2020 were included. All the data, including the way of birth was retrieved from the clinical files.One hundred and twelve patients were included (56 in the rheumatic disease group and 56 women without rheumatic diseases), two of them suffered miscarriage (one from the rheumatic disease group and 1 from the control group) giving a total of 110 products. The mean age was 29.6 years for the rheumatic patients and 24.6 for the control group. The most frequent rheumatic disease was RA in 22 patients (39.2%), followed by SLE in 13 patients (23.21%).From the 56 pregnancies on the rheumatic disease group more than half ended by cesarean section (n=33, 58.92%) and there were 22 simple vaginal delivery. Table 1. On the control group there were 24 cesarean section procedures and 31 simple vaginal delivery. The indications for cesarean sections are presented in Figure 1. No statistically significant difference was found on cesarean section prevalence between both groups (p=0.389).The most common indication for cesarean section in all patients was previous cesarean procedure. (n=12, 36.36%). There were more pathological fetal cardiotocographic changes (PFCC) as an indication for cesarean section on the rheumatic diseases group (n=11, p 0.002) compared with the control group (n=1).A higher prevalence of cesarean sections was found in women with rheumatic diseases versus women without rheumatic diseases, although this difference was not statistically significant. Studies with a higher sample size are necessary to elucidate the complications and differences between both groups.[1]Jara LJ, Cruz-Dominguez MDP, Saavedra MA. Impact of infections in autoimmune rheumatic diseases and pregnancy. Curr Opin Rheumatol. 2019;31(5):546-52.[2]Saavedra MA, Sánchez A, Bustamante R, Miranda-Hernández D, Soliz-Antezana J, Cruz-Domínguez P, et al. [Maternal and fetal outcome in Mexican women with rheumatoid arthritis]. Rev Med Inst Mex Seguro Soc. 2015;53 Suppl 1:S24-9.[3]Smeele HTW, Dolhain R. Current perspectives on fertility, pregnancy and childbirth in patients with Rheumatoid Arthritis. Semin Arthritis Rheum. 2019;49(3s):S32-s5.[4]Sugawara E, Kato M, Fujieda Y, Oku K, Bohgaki T, Yasuda S, et al. Pregnancy outcomes in women with rheumatic diseases: a real-world observational study in Japan. Lupus. 2019;28(12):1407-16.[5]Vinet É, Bernatsky S. Outcomes in Children Born to Women with Rheumatic Diseases. Rheum Dis Clin North Am. 2017;43(2):263-73.Table 1.Demographic charecteristicsDISEASEN (%)AGE, YEARS MEANDURATION OF DISEASE, YEARS MEANCESAREAN SECTIONSIMPLE VAGINAL DELIVERYOTHERSRA22 (39.2%)29.956.7711101 MiscarriageAPS9 (16.98)28.222.7781DM3(5.35%)203.521IA3(5.35%)21.5321SS4 (7.14%)30.254.7531JIA2 (3.57%)361511SLE13 (23.21)31.835.3375TOTAL5629.641509433322RA: Rheumatoid Arthritis, APS: Anti-phospholipid syndrome, DM: Dermatomyositis, IA: Idiopathic arthritis, SS: Sjogren syndrome, JIA: Juvenile idiopathic arthritis, SLE: Systemic Lupus ErythematosusNone declared