Anti Ro antibodies are relatively common and may be detected in up to 1–2% of randomly tested pregnant women. 50% of these women are otherwise asymptomatic and the remaining may present with symptoms of connective tissue disease.
Recurrent pregnancy loss may be the presentation leading to anti Ro antibody identification while they have also been associated with growth restriction, premature labour and stillbirth. Specific to anti Ro antibody positivity are the risk of congenital heart block (CHB) and cutaneous neonatal lupus erythematosus.
Studies have suggested an incidence of 1–5% of fetal CHB in women with anti Ro antibodies which rises to 6–25% in cases of a previously affected child.
With no widely accepted protocol for the prevention of CHB and the associated mortality of up to 41% in the first year of life, supporting this population of women in planning a pregnancy and during their antenatal period pose a challenge.
A cohort of more than 20 patients has been cared for in our unit between1994 to 2010. They are offered preconceptual counselling and planning with multidisciplinary surveillance and individualised care plans antenatally in the setting of a Joint obstetric/immunology and rheumatology clinic.
Each patient's care plan is based on clinical presentation, antibody titers and the previous obstetric history.
With a targeted care approach of patients at higher risk with plasma exchange and corticosteroids and with multidisciplinary surveillance and sonographic fetal surveillance offered to all anti Ro positive women during pregnancy have achieved a 67% livebirth rate, similar to our population of recurrent spontaneous abortion patients.
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