Complications maternelles graves des maladies systémiques auto-immunes

Systemic autoimmune diseases (SAID) mainly gathered connective tissue diseases with or without antiphospholipide syndrome scleroderma and systemic vasculitis. Commonly observed in systemic lupus, pregnancy is rare in vasculitis but some cases have been reported in Takayasu disease and in ANCA vasculitis. When the diagnosis is previously known, pregnancy must be carefully planned and monitored. Because pregnancy can lead to life threatening complications, some contraindications must be respected like renal insufficiency, severe hypertension, pulmonary arterial hypertension, severe cardiomyopathy or valvulopathy. Whereas pregnancy increases the risk of lupus flare, it seems not to influence the vasculitis activity. The mainly cause of intensive care unit admission in pregnant patients with SAID is infections due to the use of corticosteroids and/or immunosuppressive drugs. If flare of the disease is the cause of admission, women must usually be treated with high corticosteroid doses and if needed azathioprine because of its safety during pregnancy. Intravenous immunoglobulins and/or plasmapheresis are an interesting alternative in these situations with pathogenic autoantibodies. Maternal and foetal outcome is optimized by a multidisciplinary approach including intensivists, internists and obstetricians.