Antinuclear antibodies in infertility may be associated with implantation failure secondary to an endometriosis induced autoimmune reaction.
These antigens are essential to cell function with a role in transcription, translation, and cell cycle regulation. A positive antinuclear antibody test is the characteristic laboratory test used to help diagnose lupus. It is characterized by autoantibody production and a dysfunctional immune system resulting in organ inflammation and consequent damage. The peak incidence of SLE occurs between the ages of 15 and 40 years, with an estimated female-to-male incidence of 9:1. After full recovery patient was shifted to the ward and LMWH injections were restarted after 24 h. The surgery was uneventful with minimal blood loss. Baby cried immediately after birth with normal APGAR score and no signs of neonatal lupus. Blockade was achieved at T6 dermatome level.
Subarachnoid neuraxial block was performed using 2 ml of 0.5% Bupivacaine (heavy) in lateral position with 25G Quincke needle under aseptic precautions. Vital monitoring was carried out through oxygen saturation (SpO 2), heart rate, non-invasive blood pressure and ECG and Foleys catheter was placed to measure hourly urine output. 18G iv line was secured and patient was preloaded with 500 ml of Ringer lactate. In view of normal coagulation profile, regional anaesthesia was planned. Patient was shifted to the operation theatre. Preoperative investigations revealed a normal BT, CT, APTT and PT, INR. Injection LMWH was withheld 24 h prior to surgery. In view of bad obstetric history and precious pregnancy, an elective caesarean section was planned at term. She was being monitored by serial bleeding time (BT), clotting time (CT) and activated partial thromboplastin time (APTT) measurements. To improve the foetal outcome, she was receiving low molecular weight heparin (LMWH) 2500 IU subcutaneously twice daily. Liver and renal function tests (LFT, RFT), electrocardiograph (ECG) were further ordered to rule out any systemic involvement and were found to be normal. Her complete blood count (CBC), blood sugar, urine examination were normal. She was found to be ANA (antinuclear antibody) positive but negative for antiphospholipid antibody, although there was no history suggestive of any systemic involvement. On examination, she had mild pallor and pedal oedema.ĭuring antenatal checkups, she was investigated in view of bad obstetric history and a diagnosis of SLE was made. Patient had a history of easy fatiguability. Because of secondary infertility and cervicitis, intrauterine insemination was done 9 months back. Her obstetric history revealed that she had two consecutive abortions and had no live issues. A 25-year-old woman (G3P0L0) with 39 weeks amenorrhea, diagnosed with SLE was scheduled for elective caesarean section in view of cephalopelvic disproportion.
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