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• W2153193344 abstract "Wegener’s granulomatosis is a rare, protean disease,with even sex distribution and higher incidence inCaucasians. Its yearly incidence is 5–12 per 1000000[1] and it displays a wide range of clinical presenta-tions from a mild, localised lesion to widespread severedisease [2].The age range is wide, with the peak in the 40s.Women in the childbearing age group are not spared,and pregnancy presentsa critical condition both for theonset of the disease and for its flare-ups [2,3].The decision of a patient with Wegener’s granulo-matosistobecomepregnantpresentsaclinical dilemma[3]. To face it in the era of evidence-based medicine(EBM) and of patients’ right of self-determination,two tools, systematic literature search and physician–patient therapeutic alliance, were used together (asrecently suggested), integrating narrative and EBMproblem solving approaches [4].To address a patient’s questions, the search strategyshown in Table 1 was performed on Medline andEmbase, combining terms (Mesh–Emtree and freeterms) referring to Wegener’s granulomatosis andthose related to pregnancy.In all, reports on 28 pregnancies were retrieved(Table 1); outcome data were available for 27 of those.The diagnosis of Wegener’s granulomatosis occurredin pregnancy in eight out of 28 patients; 19 out of 27pregnancies ended in live births, seven in abortionsand two in maternal deaths (Table 1).In the reviewed literature, the most commonadvice was to not start a pregnancy in the presenceof active disease: with a clear note of caution expressedin all cases. The quality of the evidence available, how-ever, was poor, consisting of case series and casereports, presumed to be tainted by publication biases;however, such biases affect the study and discussion ofall rare diseases, especially if, as in the case of preg-nancy, the condition cannot feasibly be randomizedfor study.The present updating, performed after the patientsdecision, added only one paper to the ones retrieved bythe search strategy performed at patients referral [5]." @default.
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• W2153193344 date "2004-09-22" @default.
• W2153193344 modified "2023-09-27" @default.
• W2153193344 title "Vasculitis and kidney involvement in pregnancy: evidence-based medicine and ethics bear upon clinical choices" @default.
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• W2153193344 doi "https://doi.org/10.1093/ndt/gfh353" @default.
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