SCLERODERMA AND PREGNANCY Anaesthetic Considerations D. YOUNKER AND B. HARRISON

Diffuse scleroderma (progressive systemic sclerosis) is a rheumatic disease characterized by inflammation, vascular sclerosis and fibrosis of the skin and viscera. The aetiology is uncertain and there is no effective form of therapy. The prognosis is poor and related to the extent of visceral, rather than cutaneous, involvement (Siegel, 1977). This disorder occasionally occurs in women of child-bearing age, who appear to maintain a normal fertility index (DeCarle, 1964). Consequently, diffuse scleroderma complicating pregnancy may occur. The pregnant patient with simple acrosclerosis fares better than her counterpart with multisystem involvement. However, pregnancy has an unpredictable effect on the course of the disease (Slate and Graham, 1968). Indeed, morbidity and mortality are substantial among those mothers who develop concomitant hypertension (Fear, 1968; Karlen and Cook, 1974; Smith and Pinals, 1982). Therefore, the anaesthetist may have an integral role in the care of these high-risk parturients, especially if surgical delivery is planned. The recent report of Thompson and Conklin (1983) addresses the management of labour with regional anaesthesia. We offer the following case report to emphasize the considerations necessary for such patients if general anaesthesia is required.