Gynaecologic History in Systemic Sclerosis

Abstract

The aim of the study was to analyse the gynaecologic history of 150 Brazilian patients with systemic sclerosis (SSc) by comparing the outcome of the pregnancies before and after disease onset and in the two clinical variants of SSc, as well as to assess the effects of the pregnancy on the progress of the disease. A retrospective analysis was carried out of 150 female SSc patients, more than 18 years old, who attended the outpatient clinic of the Unit of Rheumatology of the State University of Campinas. The patients were questioned about the number of pregnancies, deliveries (full-term infants, premature births and twins) and fetal deaths (spontaneous abortions and perinatal deaths). These data were subdivided into pregnancies before and after SSc onset. In those gestations started after disease onset the patients were questioned about the evolution of SSc during the pregnancy. The patients were also asked about dyspareunia and the age at menopause. Thirty-two patients (21 %) had never been pregnant, and only five of them were considered infertile. One hundred and eighteen patients (79%) had a total of 406 pregnancies, with an average of 3.4 per patient; there were 364 pregnancies before and 42 after SSc onset. There were 58 fetal deaths (14% of the pregnancies), 50 of these occurring before and eight after disease onset; 55 were spontaneous abortions and the other three were perinatal deaths. The fertility rate was higher in the limited SSc (3.6) than in the diffuse SSc patients (3.1), although the percentage of fetal deaths and the evolution of SSc during the pregnancy were similar in the two clinical variants. In the pregnancies that occurred after the onset of SSc, the clinical course remained stable in 72% of the cases, worsened in 14% and improved in 14%. Dyspareunia was mentioned by 49 patients (37% of those with an active sexual life). Menopause was reported by 72 patients, predominantly with limited SSc (61 patients). The fertility rate in the postmenopausal SSc patients was 3.9, similar to that observed in general postmenopausal population in Brazil. The analysis of the gynaecologic history in this series of SSc patients showed no increased risk in infertility or spontaneous abortions. The fertility rate in the two SSc clinical variants was higher than that observed in the local global population. Most of the patients who became pregnant after the onset of SSc showed no signs of worsening during the course of the disease.

Desfecho da gravidez em portadoras de esclerodermia difusa e limitada

“…A SSc é doença rara que afeta predominantemente o sexo feminino, entre a terceira e a quinta décadas 7 . Em nosso estudo confirmamos este dado, tendo encontrado uma média de idade próxima aos 34 anos.…”

“…Um estudo grande (caso-controle) com 214 mulheres aponta para o mesmo sentido 8 . No que se refere a uma maior ocorrência de abortamentos conforme a forma da doença, um estudo com 150 pacientes, este de origem nacional, mostrou que a forma da esclerodermia não interfere na prevalência de abortamentos 7 . Entretanto, neste último, comparou-se apenas a diferença em portadoras da doença nas suas duas formas e a relação temporal da gestação com a manifestação clínica da doença.…”

“…A SSc afeta predominantemente o sexo feminino (3-8:1), sendo que esta relação alcança índices ainda maiores entre as idades de 15 e 50 anos (15:1). Tais achados sugerem que fatores hormonais possam contribuir com o aparecimento da doença 7 . Relatos de gestação em pacientes com SSc são incomuns e isto pode ser explicado pela raridade da doença e pela sua gravidade, que faz com que as suas portadoras evitem a gravidez.…”

Avaliação da reserva ovariana e do anticorpo anti-corpo lúteo em mulheres adultas com lúpus eritematoso sistêmico de início na infância

“…Ambas as formas, limitada e difusa, determinam quadros pulmonares que levam à fadiga e à dispnéia, com diminuição do drive sexual 17,41 . O comprometimento dos órgãos genitais com fibrose vaginal e conseqüente diminuição da elasticidade, além do ressecamento, podem dificultar a penetração ou provocar dor.…”

“…O comprometimento dos órgãos genitais com fibrose vaginal e conseqüente diminuição da elasticidade, além do ressecamento, podem dificultar a penetração ou provocar dor. Maior incidência de dispareunia foi encontrada nas pacientes com ES, estando associada ao aumento do ressecamento vaginal e presença de ulcerações e fissuras 17,41 . Além disso, o espessamento cutâneo pode levar a contraturas articulares, podendo comprometer também os quadris e dificultar assumir determinadas posições 41 .…”