Management of pregnant patient with Sjögren syndrome. Case report and literature review
L.V. Arsene, O. Munteanu, D.I. Voicu, O.M. Bodean, C. Berceanu, M.M. Cîrstoiu
Rezumat: Sjögren’s syndrome, a chronic disease which affects
particularly the female gender, represents one of the most
common autoimmune diseases and does not affect women
of childbearing age, but is especially prevalent during
perimenopause. It may be primary when only exocrine
glandular dysfunctin occurs (xerophthalmia, xerostomia)
or it may be secondary, when is most often associated with
rheumatoid arthritis or systemic lupus erythematosus and
affects the whole body. Pregnancy cases in the context of
this disease are relatively rare, precisely by their incidence
in women for whom fertility is not a priority anymore, at
the age of 40 or 50 years old, but observing the trend of
the last decades, through the implications offered by the
modern society, with the increasing age when the first
baby is conceived, the number of cases and associated
outcome increase. The pregnancy outcome in the context
of this disease is insufficiently known comparing to the
one appearing in women affected by other autoimmune
disorders. The most fearfull complication is represented by
the fetal risk of congenital heart block. We report the case
of a 29-year-old patient diagnosed with primary Sjögren’s
syndrome, consistent with AECG criteria (American-
European Consensus Group, 2002) prior to pregnancy,
which required a multidisciplinary approach and a close
cooperation between the obstetrician, rheumatologist,
ophthalmologist and internal medicine physicians. During
the 36th week of pregnancy she delivered by caesarean
section. Both the patient and the newborn postoperative
evolutions were favorable, with no evidence of fetal heart
complications.Taking into account the potential maternal
and fetal complications, the management of pregnant
women diagnosed with Sjögren’s syndrome represents
a real challenge for the obstetrician and requires an
interdisciplinary approach in order to decrease the morbidity
and mortality, both of the mother, as well as the fetus. Cuvinte cheie: pregnancy, Sjögren’s syndrome, management.