Recurrent pregnancy loss and fetal complete heart block as the initial manifestations of maternal systemic lupus erythematosus: a case report on the diagnostic and preventive role of anti-SSA (Ro) antibodies

BACKGROUND: Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disease that causes multi-organ damage and primarily affects women of reproductive age. Although pregnancy in these patients carries increased risks, advances in management have significantly improved outcomes for both the mother and the fetus. CASE PRESENTATION: A 32-year-old woman with a history of two stillbirths and an infant death due to a complete heart block (CHB) was referred at 17 weeks of gestation for fetal echocardiography, which showed no abnormalities. Further clinical evaluation revealed systemic features including painless mucosal ulcers, intermittent synovitis, and mild pericardial effusion. Positive anti-SSA (Ro) antibodies and a positive ANA test (1:80, homogeneous pattern) supported the classification of SLE. Hydroxychloroquine (HCQ) treatment was started, and follow-up echocardiograms revealed normal fetal heart function. The pregnancy progressed without complications, resulting in the birth of a healthy baby with normal cardiac findings. CONCLUSION: The diagnosis of SLE in this case was based on a combination of clinical manifestations and immunologic findings, in accordance with the ACR/EULAR 2019 criteria. While HCQ may have contributed to the favorable fetal outcome, spontaneous improvement or other modifying factors cannot be excluded. Early maternal assessment and timely initiation of treatment remain critical for optimizing outcomes in high-risk pregnancies.