Pemphigoid gestationis - a challenge for contraception
ESC Congress Library. Blidaru I. May 10, 2018; 208195; ESC301
Assoc. Prof. Iolanda E. Blidaru
Assoc. Prof. Iolanda E. Blidaru
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Abstract
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BACKGROUND Pemphigoid gestationis (PG) previously known as herpes gestationis is an unusual pregnancy-associated autoimmune skin disease. It is characterised by an itchy rash that develops into blisters commonly during the second / third trimesters of pregnancy. Basically, it is due to the individual's immune system reaction against a protein known as BPAG2 (also called BP180), found within the basement membrane of the skin which is attacked by IgG autoantibodies (PG factor) causing the damage. The sudden onset of the disease, its clinical appearance and the evolution bring great stress both on the pregnant woman and the fetus. The disease has been associated with preterm birth and intrauterine growth restriction. Corticosteroids stand as the main therapeutical approach. Returning of menstrual periods, use of hormonal contraceptives or subsequent pregnancies may cause flare-ups. CASE A 30 years old primigesta presented in labor at 37 weeks with recently ruptured membranes and a 2 cm cervical dilation. She also presented a diffuse blistering and intensely pruritic plaques that occurred periumbilically about 2 weeks ago and then spread to the rest of the body. Shortly after the admission in the hospital she was delivered by emergency caesarian section because of obvious fetal distress signs added to the fetal intrauterine growth restriction. It resulted a 2200 grams baby appreciated with an APGAR score of 8. Our patient experienced a post-delivery flare-up which led us to resume the corticosteroid therapy previously interrupted by the patient. Most symptoms resolved two weeks later. Both mother and infant had a simple postoperative evolution and were discharged on the 12th postoperative day. Our patient was counselled about important aspects of the puerperium including the issue of contraception. During the contraceptive counselling it became clear that she previously would like to become a pill user. After informing about her particular OCP-related risks, she could not decide on a safe enough non-hormonal method. CONCLUSION PG is a rarely reported disease and, by reporting this, we intend to draw clinicians' attention regarding this condition. PG poses multiple challenges regarding the diagnosis and treatment both for the obstetrician and the dermatologist but also in terms of choosing an appropriate contraceptive method. KEYWORDS: Pemphigoid gestationis; autoimmune disease; dermatoses of pregnancy; contraception.
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