Background/Purpose: Pregnant SLE women are at increased risk of cesarean delivery compared to pregnant women from the general population. Yet, to date, no one has evaluated the indications for cesarean delivery in SLE pregnancies. Using the large population-based “QUAlity of care, obstetrics RISk MAnagement, and mode of delivery (QUARISMA)” cohort, we assessed indications for cesarean delivery in SLE pregnancies versus unaffected pregnancies.

Methods: The QUARISMA cohort includes 184,952 pregnancies and was established as part of a cluster-randomized, controlled trial, which aimed to evaluate the effect of a 1.5-year intervention, involving audits of indications for cesarean delivery and feedback to healthcare professionals, at 32 hospitals in Quebec (2008-2011). The intervention had a small effect on the rate of cesarean delivery (Chaillet, NEJM, 2015). As part of the trial, in-hospital data, including maternal SLE status and information on indications for cesarean delivery, were abstracted by trained professionals from the medical records.

For the present study, we individually matched 4:1 SLE pregnancies to unexposed pregnancies on maternal age, parity, body mass index (BMI), hospital of delivery, QUARISMA intervention group, and intervention period. We identified cesarean deliveries in SLE and unexposed pregnancies, and ascertained their indications. We performed multivariate analyses to estimate the risk of cesarean delivery for any indications, as well as the risk of cesarean delivery for fetal distress (e.g. cardiac distress, prematurity, intra-uterine growth restriction, stillbirth), maternal disease, and/or preeclampsia in SLE pregnancies versus controls, adjusting for BMI and multiple births.

Results: We identified 122 SLE pregnancies and 488 unexposed pregnancies. Cesarean deliveries occurred in 35/122 (29%) of SLE pregnancies versus 132/488 (27%) of unexposed pregnancies. Among the 35 SLE cesarean deliveries, indications included (but were not limited to) cardiac distress in 34%, prematurity in 29%, maternal disease in 20%, and preeclampsia in 11%. Among the 132 unexposed cesarean deliveries, 28% were due to cardiac distress, 10% to prematurity, 4% to maternal disease, and 6% to preeclampsia. In multivariate analyses, there was a trend for an increased risk of cesarean delivery for any indications in SLE versus unexposed pregnancies (OR 1.6; 95% CI 0.9,2.9). Moreover, SLE pregnancies had a substantially increased risk of cesarean delivery for fetal distress, preeclampsia, and/or maternal disease versus unexposed pregnancies (OR 2.6; 95% CI 1.2,5.3).

Conclusion: Cesarean deliveries in SLE pregnancies are more often due to fetal distress, preeclampsia, and/or maternal disease than cesarean deliveries in pregnancies from the general population.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/indications-for-cesarean-delivery-in-systemic-lupus-erythematosus-pregnancies/