At Saint Mary’s Hospital, we run a specialist antenatal clinic for pregnant women with Lupus Spectrum disorders including Systemic Lupus Erythematous (SLE), incomplete Lupus Syndrome and the Anti-phospholipid syndrome (APS) as well as other connective tissue disorders. These disorders are associated with serious problems during pregnancy such as pregnancy loss, pre-eclampsia, premature birth and failure of the baby to grow.
The specialist team within the clinic provides pre-conception advice, routine antenatal care such as blood pressure and urine checks, routine antenatal advice, detailed ultrasound observations of the baby and placenta, monitoring of medication, monitoring of blood tests, monitoring and management of symptoms related to the specific disorder such as ‘flare ups’. Surveillance of maternal and fetal health is tailored to individual requirements and a care plan is made for the antenatal period in addition to labour and birth. In particular, it is very important to make sure that the disease is well controlled before and during pregnancy.
Embedded in the clinical service is an active research programme within the Maternal and Fetal Health Research. This study aims to collect information about pregnancies in women with Lupus-like disorders and other connective tissue diseases in order to help us understand pregnancy in women with these disorders better. We hope that by collecting information like this, we can better look after women and improve outcomes of pregnancy in the future. You may be invited to take part in the research study and will be sent the information with the appointment letter. Women should be reassured that their decision to help or not with the research project does not influence their clinical care.
We see women with:
- Systematic Lupus Erythematosus (SLE).
- Incomplete Lupus Syndrome.
- Anti-phospholipid Syndrome (APS).
- Other connective tissue diseases, including scleroderma/ systemic sclerosis, granulomatosis, Sjogren’s syndrome, dermatomyositis and others.
- Pre-conception consultations to improve disease control and check that medications are safe to take during pregnancy. It is really important to make sure you do not suddenly stop any medications without medical advice.
- Antenatal care.
- Management of Lupus in pregnancy including additional pregnancy scans.
- Opportunity to be involved in research.
- Some women are also offered a postnatal appointment after the baby is born
Clinics are held on the 5th Floor, Maternal and Fetal Health Research Centre, Saint Mary’s Hospital, Oxford Road Campus, every Tuesday afternoon.
Women are seen jointly in the clinic within the multi-disciplinary team, which consists of a team of rheumatologists, midwives and obstetricians:
Dr Clare Tower – Consultant Obstetrician/ Fetal and Maternal Medicine
Dr Louise Simcox – Consultant Obstetrician/ Fetal and Maternal Medicine
Professor Ian Bruce – Consultant Rheumatologist
Sue Thornber – Specialist midwife
At some consultations you will see both an obstetrician and a rheumatologist together, but sometimes it may only be necessary to see either the obstetric or rheumatology team members. Sometimes you will be seen by a midwife. Sometimes we have senior trainee doctors and observers, including medical students, in the clinic too. At some appointments you may also need a scan of your baby and some blood tests, so be prepared to be in the clinic for several hours. Please also make sure you bring a urine sample to the clinic if you are pregnant.
With some women we also involve the anaesthetic team, particularly in the management of pain relief for labour and birth.
You may find it useful to think through any questions you might have before coming to the clinic; some women find it helpful to write these down.
How will I be treated?
Your care will be tailored dependent on the disorder. Some disorders require intensive monitoring and treatment. We are also able to offer telephone and video consultations. Sometimes, the team may need to contact you by phone, with results or clinic appointments. The hospital phone numbers are withheld, so may appear on your phone as a withheld number or no caller ID. Please look out for these phone calls if you have been referred to the clinic and answer the call if it is convenient to do so. Sometimes we need to refer you to some of our other specialist clinics as many rheumatological disorders can be very complex and involve multiple parts of the body.
All women receive an individual care plan for the birth of their baby.
How do I access the service?
Women can be referred to the service via:
- Their GP.
- Reproductive Health Service.
- Rheumatology team.