Managing Rheumatic Conditions During Pregnancy: Natural vs. Cesarean Delivery

Concerns about reproductive issues related to rheumatic and immune disorders?

Hello, doctor.
Since childhood, I have experienced redness, swelling, and pain in various joints, which can become severe enough to make movement extremely difficult and painful.
These episodes usually last several days.
I currently undergo regular blood tests, and my doctor informed me that I had juvenile rheumatism as a child, and now I am diagnosed with recurrent rheumatism and ankylosing spondylitis.

1) I would like to ask if having an episode during natural childbirth would pose any risks to the delivery process.

2) Would a cesarean section be more suitable for me? My thinking is that this way, I wouldn't have to worry about my condition flaring up during labor, which would contribute to a healthier mental state during pregnancy.
It’s hard to imagine going through childbirth while dealing with a flare-up, as even movement becomes an issue during those times, which is a major concern for me.

3) Additionally, I have a 1.6 cm chocolate cyst on my left ovary and a 2.4 cm teratoma (recurrent) on my right ovary.
Would it be appropriate to address both the cesarean section and the teratoma simultaneously? Thank you for your assistance.

Hua'er, 30~39 year old female. Ask Date: 2022/01/09

Dr. Cao Guotao reply Obstetrics and Gynecology

Hello, if there are issues with mobility during labor, a cesarean section may need to be considered.
Regarding the surgery, health insurance regulations state that ovarian issues cannot be addressed simultaneously.
Wishing you good health.

Reply Date: 2022/01/09

More Info

Managing rheumatic conditions during pregnancy can be quite complex, particularly when considering the mode of delivery—natural versus cesarean. Your concerns regarding the impact of your rheumatic conditions, specifically recurrent rheumatism and ankylosing spondylitis, on the delivery process are valid and deserve careful consideration.

1. Impact of Rheumatic Conditions on Natural Delivery: If you experience a flare-up of your rheumatic condition during labor, it could indeed pose challenges. Severe pain and mobility issues may hinder your ability to cope with labor, which often requires physical endurance and mobility. In a natural delivery, the ability to move and change positions can significantly aid in managing labor pain and facilitating the delivery process. If your condition flares up, it could lead to increased stress and anxiety, potentially complicating the delivery. Therefore, it is crucial to have a comprehensive management plan in place, including pain management strategies and support from your healthcare team.

2. Considering Cesarean Delivery: Given your concerns about the unpredictability of your condition during labor, opting for a cesarean delivery may be a more suitable choice for you. A planned cesarean can alleviate the anxiety of experiencing a flare-up during labor, allowing for a more controlled environment. Additionally, it can help ensure that you are in a stable condition when the delivery occurs, minimizing the risk of exacerbating your symptoms. However, it is essential to discuss this option thoroughly with your obstetrician and rheumatologist, as they can provide insights tailored to your specific health situation.

3. Managing Ovarian Cysts During Delivery: Regarding your ovarian conditions, such as the chocolate cyst and the teratoma, it is generally not advisable to address these issues simultaneously with a cesarean delivery unless there is a compelling medical reason. Most healthcare providers prefer to manage these conditions separately to minimize surgical risks and complications. The presence of these cysts may not directly impact your delivery method, but they should be monitored closely throughout your pregnancy. Your healthcare team will likely recommend a follow-up plan post-delivery to address these cysts appropriately.

In conclusion, managing rheumatic conditions during pregnancy requires a multidisciplinary approach. It is vital to maintain open communication with your healthcare providers, including your obstetrician and rheumatologist, to develop a tailored plan that addresses your unique needs. This plan should encompass pain management strategies, delivery method considerations, and monitoring of any additional health concerns, such as your ovarian cysts. By doing so, you can help ensure a healthier pregnancy and delivery experience, while also addressing your concerns about your rheumatic conditions. Always prioritize your health and well-being, and do not hesitate to seek support from your medical team throughout this journey.

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