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Dr Max Mongelli
Department of Obstetrics & Gynaecology
University of Sydney
Australia
Autoimmune disorders:
Graves’ Disease
Hashimotos’ Disease
Graves’ Disease
Hyperthyroidism
Goitre
Ophthalmopathy
Pretibial myxedema
Antibodies to TSH receptor
Hashimotos’ Thyroiditis
“Chronic autoimmune thyroiditis”
Most common cause of hypothyroidism
Gradual thyroid failure or goitre
Autoimmune destruction of thyroid gland
Sex ratio 7:1
Antibodies against TG, TPO, TSH receptor
Diagnosis of Hyperthyroidism in
Pregnancy
Graves’ Disease
Gestational Transient Thyrotoxicosis - HCG
mediated
Molar pregnancy
Familial gestational thyrotoxicosis
Hyperthyroidism in Pregnancy
Increased risk of -
Miscarriage
Premature labour
Low birth weight
Stillbirth
Pre-eclampsia
Heart failure
Hypothyroidism in Pregnancy
Disease exacerbation
Miscarriage, stillbirth
IUGR, preterm labour
Neonatal lupus
Drugs and breast-feeding
Neonatal Lupus:
Occurs in up to 2% of mothers with SLE
Targets skin and cardiac tissue,rarely other tissues
Congenital partial or complete heart block
Heart block detected in utero
Complete heart block: PNM of 44%
Rash: erythematous annular lesions
Rash clears within 6/12
Maternal dexamethasone may prevent progression
of heart block
Neonatal pacemaker if HR<55
Antiphospholipid antibodies
Anti-cardiolipin
Lupus anticoagulant
Increased risk of miscarriage
Risk may be reduced with aspirin +
heparin
Investigations for SLE in pregnancy:
Isolated thrombocytopenia
No drugs or other conditions that may
affect platelet count
Exclude HIV, Hep C, SLE
ITP – Pathology:
Incidence about 5%
Occurs late in pregnancy
Mild (>70 000)
No fetal neonatal thrombocytopenia
Postpartum resolution
Rheumatoid Arthritis
Rheumatoid Arthritis in Pregnancy