Anesthetic management for elective lower segment cesarean section in a patient with systemic lupus erythematosus and thrombocytopenia

Systemic lupus erythematosus is a multisystem, chronic infl ammatory disease characterized by autoantibodies directed against nuclear antigens. The disease is most frequently found in women of child-bearing age and therefore may coexist with pregnancy. The clinical symptoms are variable and depend on the severity of damage to organ systems such as the musculoskeletal, renal, hematological, neurological, cardiac, and respiratory systems. The pregnant patient may experience exacerbations of disease, neonatal loss, and obstetric complications such as pre-eclampsia.The anesthetic management will depend on the patient’s clinical status and the well-being of the fetus. The patient should be thoroughly examined for the extent of end-organ damage, current medications, and the health of the fetus. Laboratory investigations, such as coagulation profi les and testing for renal functions, should be performed and enough amount of blood substitutes should be kept ready before anesthetic intervention if time permits. A multidisciplinary approach by the obstetrician, the anesthesiologist and the hematologist for regular antenatal checkups, proper preoperative evaluation, and rational preparation of blood substitutes, with the availability of enough resources to manage complications during the entire course of the peripartum period, is essential to optimize the outcome for both the mother and the newborn.