Placenta accrete after a frozen-thawed embryo transfer in a systemic lupus erythematosus patient treated with hydroxychloroquine

Autor: Naoyuki Miyasaka, Takayuki Tatsumi, Kazuki Saito, Masaki Sekiguchi, Chihiro Mano, Yuki Iwahara, Shiro Hiramitsu, Tomonori Ishikawa
Rok vydání: 2020
Předmět:
Adult
Pathology
medicine.medical_specialty
Reproductive Techniques
Assisted
Placenta accreta
Endocrinology
Diabetes and Metabolism
030209 endocrinology & metabolism
Placenta Accreta
Endometrium
03 medical and health sciences
0302 clinical medicine
Endocrinology
Japan
Pregnancy
immune system diseases
Maldevelopment
Placenta
Freezing
medicine
Humans
Lupus Erythematosus
Systemic
skin and connective tissue diseases
reproductive and urinary physiology
Cryopreservation
030219 obstetrics & reproductive medicine
Cesarean Section
business.industry
Infant
Newborn
Pregnancy Outcome
Obstetrics and Gynecology
Hydroxychloroquine
Embryo Transfer
medicine.disease
Embryo transfer
Pregnancy Complications
Blastocyst
Treatment Outcome
medicine.anatomical_structure
Female
business
Infertility
Female
medicine.drug
Zdroj: Gynecological Endocrinology. 36:843-846
ISSN: 1473-0766
0951-3590
Popis: Placenta accreta (PA) is a life-threatening disorder associated with decidual maldevelopment and a thin endometrium. Few cases of systemic lupus erythematosus (SLE) pregnancy complicated by PA have been reported, and the background pathophysiology remains elusive. Here, we report a case of PA in SLE pregnancy treated with hydroxychloroquine. A nulligravida woman with SLE, aged 41 years, visited our hospital because of infertility problems. Her SLE was treated with prednisolone and tacrolimus. We conducted assisted reproductive technology and gained several embryos. An artificial cycle successfully prepared the endometrium for embryo transfer with sufficient thickness. Over time, her SLE exacerbated, and we started hydroxychloroquine administration. Consequently, the endometrium did not respond to hormonal supplementation and remained thin, but we transferred the embryo and managed to achieve pregnancy. On the 38th week of gestation, we conducted labor induction because of elevated blood pressure. Induction was not effective, so we performed cesarean section; PA was observed. We performed compression suturing and were able to stop the hemorrhage. Postoperative uterine infarction and pelvic infection were successfully managed with conservative treatment. The present case highlights the use of hydroxychloroquine during endometrial development and contributes evidence regarding the pathogenesis of PA in pregnancy complicated by SLE.
Databáze: OpenAIRE
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