Foetal Surveillance and Pregnancy Management in Women with Rheumatic Diseases

Pregnant women with autoimmune rheumatic disease (AIRDs) are at higher risk for many maternal and foetal complications which are mediated by placental disease. Placental dysfunction is largely responsible for significant maternal and perinatal morbidity related to placental abruption, preeclampsia, preterm birth, and foetal growth restriction. Clinical measures to monitor placental function and its impact on foetal growth and development are primarily directed toward antepartum stillbirth prevention and the reduction of perinatal morbidity. Prevention of antepartum non-anomalous stillbirth remains a significant challenge for both low- and high-income settings around the world. However, it is well understood that improved detection of the Small-for-Gestational-Age (SGA) fetus can help lower antepartum stillbirth rates for women at risk, which include those with AIRDs. Risk of stillbirth is largely reliant upon the performance of selective foetal growth ultrasound to detect SGA.  The accuracy of foetal growth assessment is therefore integral to obstetric management of women with AIRDs and attention to novel screening approaches will be important to offset pathology driven by placental disease.