Management of Pre-Existing Systemic Lupus Erythematosus in Pregnancy: A Case Report

Background: Patients with systemic lupus erythematosus (SLE) often face difficulty in conceiving and may experience recurrent pregnancy losses. Therefore, achieving a successful pregnancy is particularly precious to them. Case Summary: We report the case of a 24-year-old primigravida with pre-existing SLE who successfully underwent labor induction at 38 weeks of gestation. Her pregnancy was managed with hydroxychloroquine, azathioprine, low-dose prednisolone, and prophylactic anticoagulation. She remained clinically stable throughout pregnancy, with no significant disease flares. Labor was induced using dinoprostone, and she delivered a healthy infant via spontaneous vaginal delivery. Postpartum management included thromboprophylaxis and close monitoring for lupus reactivation. Successful pregnancy outcomes in SLE require preconception counseling, medication optimization, and close maternal-fetal surveillance especially in low-income settings. Hydroxychloroquine plays a central role in reducing lupus activity and neonatal complications. Individualized anticoagulation strategies help mitigates thrombotic risks. This case highlights the importance of multidisciplinary collaboration in optimizing maternal and fetal outcomes. Conclusion: Patients with SLE can achieve favorable pregnancy outcomes with appropriate planning, medication adjustments, and vigilant monitoring. A multidisciplinary approach remains crucial in mitigating potential complications. Core Tip: A 24-year-old Kenyan primigravida with quiescent systemic lupus erythematosus (SLE) achieved uncomplicated term vaginal delivery under a multidisciplinary regimen of azathioprine (AZA), hydroxychloroquine (HCQ) and 5 mg prednisolone, plus prophylactic enoxaparin and aspirin. The case illustrates that continuing steroid-sparing therapy and individualized thromboprophylaxis throughout pregnancy can secure optimal maternal and fetal outcomes even in resource-limited settings.