Critical Care Obstetrics part 50 provides expert clinical guidance throughout on how you can maximize the chances of your patient and her baby surviving trauma. In this stimulating text, internationally recognized experts guide you through the most challenging situations you as an obstetrician are likely to face, enabling you to skillfully:Recognize conditions early-on which might prove life threatening, Implement immediate life-saving treatments in emergency situations, Maximize the survival prospects of both the mother and her fetus | Systemic Lupus Erythematosus and Antiphospholipid Syndrome Long-term use of all NSAIDs has been associated with decreased fetal urinary output and oligohydramnios as well as neonatal renal insufficiency 79 . Given these risks chronic use of adult dosages of aspirin and other NSAIDs should be avoided during pregnancy. Acetaminophen- and narcotic-containing preparations are acceptable alternatives if analgesia is needed during pregnancy. Other treatments Several new treatment regimens including cyclosporin high-dose intravenous immune globulin IVIG mycophenolate mofetil and thalidomide have been studied in the treatment of nonpregnant patients with SLE 1 . Only IVIG has been used during pregnancy without reports of adverse fetal effects. Obviously thalidomide is strictly contraindicated during pregnancy because of its known potent teratogenicity. Complete immunoablative therapy followed by bone marrow stem cell transplantation has also been studied in patients with the most severe unresponsive SLE 1 . Treatment of SLE flare during pregnancy Mild to moderate symptomatic exacerbations of SLE without CNS or renal involvement may be treated with initiation of glucocorticoids or an increase in the dose of glucocorticoids. Relatively small doses of prednisone . 15-30mg day will result in improvement in most cases. For severe exacerbations without CNS or renal involvement doses of kg day of prednisone in divided doses should be used and a good clinical response can be expected in 5-10 days. Thereafter glucocorticoids may be tapered by several different approaches Table . Severe exacerbations especially those involving the CNS or kidneys are treated more aggressively usually with intravenous pulse glucocorticoid therapy The initial regimen involves a daily intravenous dose of methylprednisolone at 10-30mg kg about 500-1000 mg for 3 to 6 days. Thereafter the patient is treated with kg day of prednisone in divided doses rapidly tapered over the .
