Clinical Outcomes and Perinatal Results in Pregnant Patients with Systemic Lupus Erythematosus in the Intensive Care Unit

Abstract

Aim: To identify the clinical outcomes and perinatal results in patients with SLE (Systemic Lupus Erythematosus) managed in the intensive care unit (ICU). Study Design:  Retrospective, observational and descriptive study. Place and Duration of Study: ICU of the High Specialty Medical Unit of Gynecology and Obstetrics Hospital No. 3, National Medical Center “La Raza” belonging to the Mexican Institute of Social Security in Mexico City, between January 1, 2017 and July 31, 2024. Methodology: A retrospective, observational and descriptive study was carried out in a cohort of 41 pregnant patients with SLE admitted to the ICU in the years 2017 to 2024. The records were consulted to know their general data, clinical outcomes and perinatal results. For data analysis, descriptive statistical measures were used with the statistical program SPSS™ version 22.0. Results: ICU admission data: maternal age 28.1±5.30 years, pregnancy 28±8 weeks. Time of SLE diagnosis 6.16±4.87 years. Reasons for ICU admission: preeclampsia-eclampsia 36.56%, uncontrolled chronic hypertension 29.26% and lupus activity 12.19%. Antihypertensive agents were required in 80.48%, vasoactive amines in 4.87%, cardiotonic agents 2.43%, antiarrhythmic drugs 2.43%, transfusion therapy 46.34%, and mechanical ventilatory support 19.51%. Mode of termination of pregnancy: cesarean section 67.50%, instrumented uterine curettage 17.50%, vaginal delivery 10% and hysterotomy 5%. Complications: postpartum hemorrhage 15%, incidental injury to an iliac vein 5%, surgical reintervention 5%, choriamnioitis 2.5%, intestinal laceration 2.5%% and unpacking 2.5%. ICU stay 3.43±2.66 days. Prolonged stay in the ICU (>8 days) was found in 7.31%. Maternal mortality 0%. Preterm products 76.92%, and term products 23.08%, survival 63.41%, overall fetal mortality 36.59% (abortion 19.51%, utero death 4.87%, and perinatal death 12.19%). Conclusion: The maternal clinical outcomes was satisfactory. Perinatal results were unfavorable with high rates of prematurity, abortion, in utero death, and perinatal death.