Pregnancy and childbirth after treatment with autologous hematopoietic stem cell transplantation for severe systemic sclerosis requiring parenteral nutrition. Ethical issues

We report a pregnancy in a patient who had undergone autologous hematopoietic stem cell transplantation (AHSCT) for diffuse cutaneous systemic sclerosis (SSc). SSc onset was at age 25, with Raynaud phenomenon and evolved to include diffuse cutaneous, arthritis, pulmonary fibrosis and extensive gastr...

Full description

Saved in:

Bibliographic Details
Published in:	Clinical and experimental rheumatology Vol. 26; no. 6; pp. 1122 - 1124
Main Authors:	TYNDALL, A. J, JOLY, F, CARBONNE, B, DELIGNY, C. N, FARGE, D. C
Format:	Journal Article
Language:	English
Published:	Pisa Clinical and Experimental Rheumatology 01-11-2008
Subjects:	Adult Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Biological and medical sciences Diseases of the osteoarticular system Emergency and intensive care: metabolism and nutrition disorders. Enteral and parenteral nutrition Ethics, Medical Fatal Outcome Female Hematopoietic Stem Cell Transplantation Humans Infant, Newborn Intensive care medicine Medical sciences Parenteral Nutrition Pregnancy Pregnancy Complications Pregnancy Outcome Prognosis Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis Scleroderma, Systemic - diet therapy Scleroderma, Systemic - therapy Severity of Illness Index Antineoplastic agent Immunopathology Connective tissue disease Skin disease Rheumatology Stem cell transplantation Autoimmune disease Parenteral nutrition Parenteral administration Pregnancy Ethics Autograft Cyclophosphamide Treatment systemic sclerosis Fertility Systemic disease Scleroderma
Online Access:	Get full text
Tags:	Add Tag No Tags, Be the first to tag this record!

Description
Summary:	We report a pregnancy in a patient who had undergone autologous hematopoietic stem cell transplantation (AHSCT) for diffuse cutaneous systemic sclerosis (SSc). SSc onset was at age 25, with Raynaud phenomenon and evolved to include diffuse cutaneous, arthritis, pulmonary fibrosis and extensive gastrointestinal involvement. AHSCT (cyclophosphamide/ATG for conditioning) was performed four years later with improvement of all features apart from the gastrointestinal symptoms requiring parenteral nutrition (PN). Forty months after AHSCT, she had a spontaneous miscarriage necessitating curettage. Despite advice to avoid pregnancy because of poor nutritional status and recurring catheter infections from her PN, she fell pregnant one year later. The pregnancy proceeded normally and she delivered at 34 weeks, under cesarean section. The baby girl, (1990g and 4 APGAR score) after initial respiratory distress, is now 4 years old with normal growth and development. Unfortunately, the patient died early in 2008 due to severe disease progression terminating with gastrointestinal obstruction and pericarditis. This first report of a successful pregnancy in a patient with diffuse SSc treated by AHSCT illustrates that despite the possibility for a normal pregnancy, the decision to do so includes aspects of maternal prognosis.
Bibliography:	ObjectType-Case Study-2 SourceType-Scholarly Journals-1 ObjectType-Feature-4 content type line 23 ObjectType-Report-1 ObjectType-Article-3
ISSN:	0392-856X 1593-098X