imagem top

2019

ANUÁRIO DO HOSPITAL
DONA ESTEFÂNIA

CHULC LOGOlogo HDElogo anuario

ANKYLOSING SPONDYLITIS – EFFECTS ON PREGNANCY. CASE REPORT

Vanessa Olival, Margarida Enes, Maria João Nunes, Manuela Caetano, Ricardo Mira.


Serviço de Ginecologia Obstetrícia, Hospital de Dona Estefânia, Centro Hospitalar de Lisboa Central, E.P.E.

- COGI, Congresso Internacional (poster).

Problem Statement: Ankylosing spondylitis (AS) is a chronic inflammatory disease of the axial skeleton presenting with progressive pain and stiffness. It affects mainly young adults in the third and fourth decades, is less frequent in females and affects about 0.5% to 1% of white race people. It has been associated with psoriasis and inflammatory bowel diseases; 85-95% is HLA-B27-related. During pregnancy, the fetus works as a natural antigen, however protective immunological mechanisms lead to maternal tolerance.

Methods: We report a case of a 27-year old pregnant with AS showing discrete symptom worsening but a regular course of pregnancy and delivery.

Results: Pregnant, 27 years, IO 0010, with prior history of AS, referred to Maternal-Fetal Department at 15 weeks of gestational age. The disease had so far had been controlled with anti-inflammatory drugs, painkillers and physiotherapy. The patient was informed that AS was not expected to interfere with the fetus. Parenteral administrations of analgesics at the emergency department were necessary for symptomatic relief. Delivery took place at 40 weeks + 3 days by emergency c-section with loco-regional anaesthesia on account of non-reassuring fetal status; the newborn was healthy, weighted 4170g and had an apgar score of 9/10. A normal puerperium followed delivery.

Conclusion: AS is a chronic disease, with difficult symptom control using available medication. During pregnancy, there are therapeutic limitations, however avalilable data show that the ASactivity is not increased by pregnancy and neither has the latter a worse outcome. AS doesn't counter-indicate vaginal childbirth or loco-regional anaesthesia.

Keywords: HLA-B27, chronic inflammatory disease.