Placenta accrete after a frozen-thawed embryo transfer in a systemic lupus erythematosus patient treated with hydroxychloroquine

Abstract

Placenta accreta (PA) is a life-threatening disorder associated with decidual maldevelopment and a thin endometrium. Few cases of systemic lupus erythematosus (SLE) pregnancy complicated by PA have been reported, and the background pathophysiology remains elusive. Here, we report a case of PA in SLE pregnancy treated with hydroxychloroquine. A nulligravida woman with SLE, aged 41 years, visited our hospital because of infertility problems. Her SLE was treated with prednisolone and tacrolimus. We conducted assisted reproductive technology and gained several embryos. An artificial cycle successfully prepared the endometrium for embryo transfer with sufficient thickness. Over time, her SLE exacerbated, and we started hydroxychloroquine administration. Consequently, the endometrium did not respond to hormonal supplementation and remained thin, but we transferred the embryo and managed to achieve pregnancy. On the 38th week of gestation, we conducted labor induction because of elevated blood pressure. Induction was not effective, so we performed cesarean section; PA was observed. We performed compression suturing and were able to stop the hemorrhage. Postoperative uterine infarction and pelvic infection were successfully managed with conservative treatment. The present case highlights the use of hydroxychloroquine during endometrial development and contributes evidence regarding the pathogenesis of PA in pregnancy complicated by SLE.

摘要

植入性胎盘(PA)是一种与蜕膜发育不良和子宫内膜变薄相关的危及生命的疾病。系统性红斑狼疮(SLE)妊娠合并PA的报道很少, 其背景病理生理学仍不清楚。在此, 我们报告一例应用羟基氯喹治疗SLE妊娠合并PA的病例。一位患有SLE的不孕妇女, 41岁, 因不孕问题来我院就诊。她的系统性红斑狼疮用强的松龙和他克莫司治疗。我们进行了辅助生殖技术, 获得了几个胚胎。人工周期成功地为胚胎移植准备了足够厚度的子宫内膜。随着时间的进展, 她的系统性红斑狼疮恶化了, 我们开始给她注射羟基氯喹。因此, 子宫内膜对激素补充没有反应, 仍然很薄, 但我们移植了胚胎, 并设法实现了怀孕。妊娠38周时, 因血压升高进行引产。引产无效, 行剖宫产, 发现PA。我们进行了加压缝合, 并能够止血。术后子宫梗死和盆腔炎经保守治疗均获成功。本病例强调了羟氯喹在子宫内膜发育过程中的应用, 并为妊娠合并SLE的PA的发病机制提供了证据。

The Chinese abstracts are translated by Prof. Dr. Xiangyan Ruan and her team: Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, China.

Keywords:

• Artificial cycle
• endometrium
• frozen-thawed embryo transfer
• hydroxychloroquine
• placenta accreta

Acknowledgements

We would like to thank Editage (www.editage.com) for English language editing.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This study was supported by Health and Labor Sciences Research Grants [H30-Sukoyaka-Ippan-002].