Initial Results of a Rheumatology and Obstetric Service
K Murray, L Moore, C O’Brien, A Clohessy, C Brophy, O FitzGerald, ES Molloy, AB Mongey, S Higgins, MF Higgins, P Minnock, FM Mc Auliffe and DJ Veale
Rheumatology Department, University College Dublin and St. Vincent’s University Hospital, Dublin, Ireland Our Lady’s Hospice and Care Services, Harold’s Cross, Dublin,Ireland UCD Perinatal Research Centre, Obstetrics and Gynaecology, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
Rheumatic musculoskeletal disease (RMD) patients when family planning must consider fertility, disease activity and management from pre-conception to lactation. In a 2013 national survey, Irish women with RMD expressed dissatisfaction about the information and care received. To address this, in May 2017, we created the Rheumatology and Obstetric Servie (ROSE) Clinic in the National Maternity Hospital.
To record data on rheumatic disease patients reproductive health outcomes.
RMD patients with reproductive health needs are treated by a multidisciplinary team (rheumatologists and rheumatology advanced nurse practitioners, obstetricians, midwives, maternal medicine specialists and pharmacists). We identify patients’ emotional and healthcare needs, ensure access to expert advice, maintenance of good disease control and positive reproductive outcomes using our evidence based antenatal, pregnancy and postpartum care pathways. Patient outcomes are measured.
42 women with median age (range) of 33 years (27-41) have been cared for by this service.
Patient diagnoses were SLE (n=11), rheumatoid arthritis (9), psoriatic arthritis (6), Sjogren’s syndrome (4), antiphospholipid syndrome (2), undifferentiated connective tissue disease (2). There were one case of each of the following condtions: ankylosing spondylitis, reactive arthritis, Behcet’s disease, Takayasu’s arteritis, mixed connective tissue disease, granulomatosis with polyangitis, scleroderma, spondyloepiphyseal dysplasia congenital, Ehlers Danlos syndrome type 3.
Fifteen patients were on synthetic DMARDs, six on prednisolone, eight on TNF inhibitors, two on non TNF inhibitors, three on aspirin and two on low molecular weight heparin.
There have been 22 successful pregnancies and 23 babies born (one set of twins). There were 7 spontaneous vaginal deliveries, 1 forceps delivery, 4 operative vaginal deliveries and 10 Caesarean sections (2 elective for breech, 6 other elective and 2 emergency). Median (range) birth weight was 3.5kg (1.9-4.4kg). There has been one miscarriage. One patient had post-partum complications (wound infection and mastitis).
These data show 22/23 (96%) successful birth outcomes in women with RMD and a low rate of postpartum complications. 10 patients were on biologic DMARDs.