Dr Esther Park1, Miss Kerry Munro1, Dr Anne Kinderlerer1, Dr Melissa Wickremasinghe1, Dr Charlotte Frise1
1Imperial College Healthcare NHS Trust, London, United Kingdom
Biography:
Dr Esther Park is a clinical training fellow in obstetric medicine at Queen Charlotte's and Chelsea Hospital, London. She has a background in acute internal medicine.
Abstract:
Introduction: Antisynthetase syndrome (ASS) is an autoimmune condition characterised by autoantibodies against aminoacyl tRNA synthetases, resulting in muscle inflammation and interstitial lung disease (ILD). Very few cases of ASS have been reported in pregnancy.
Case: A 25-year-old woman had been diagnosed with anti-PL-7 ASS four years prior to conception. After pre-pregnancy counselling she stopped mycophenolate. She received rituximab in first trimester, but despite this, her respiratory function deteriorated and she required home oxygen in the second trimester. She received several courses of antibiotics for presumed lower respiratory tract infection. A further decline at 36 weeks’ gestation led to admission. Her respiratory function and oxygen saturation deteriorated further, and this in combination with patient anxiety about the stress of delivery, led to delivery by emergency caesarean section being undertaken. Delivery was uncomplicated and the baby was well. The patient received pulsed methylprednisolone for 3 days in total following delivery. Her respiratory function rapidly improved postnatally and she remains stable six months after delivery.
Conclusions:
– ASS is rare in pregnancy, so education and improving clinician familiarity with the condition is important. The presence of ILD and diagnosis during pregnancy appear to be associated with poorer maternal and fetal outcomes.
– Diagnostic vigilance is required to ensure an exacerbation of the underlying condition is not mistakenly attributed to acute illness such as infection.
– Lung function tests, echocardiography, regular monitoring of creatine kinase levels and regular clinical review are required during pregnancy to facilitate the early detection of deterioration.
– Vaginal delivery is not contraindicated but caesarean delivery may be required for obstetric indications or severe maternal illness.
– Pre-pregnancy optimisation, regular monitoring and multidisciplinary approach involving respiratory physicians, rheumatologists, obstetric physicians, obstetricians and anaesthetists are essential.
Keywords
Anti-synthetase syndrome, interstitial lung disease, pregnancy