Table 1.

A QI set for pregnancy and childbirth in SLE patients.

Denominator of QINumerator of QI
QI 1-1Female patients with SLE planning for pregnancyPatients who consulted an obstetrician
QI 1-2Female patients of childbearing age with SLEPatients explaining the need for a planned pregnancy
QI 1-3Female patients of childbearing age with SLE who are aPL negative, have stable or low disease activity, have no desire to have a baby, and wish to use contraceptionPatients proposed effective contraceptive methods (e.g. hormonal contraceptives or intrauterine devices)
QI 1-4Female patients of childbearing age with SLE of moderate-to-severe disease activity, including nephritisPatients proposed to use progestin-only contraceptive pills or intrauterine device for contraception
QI 1-5Male patients with SLE who have not started treatment with gonadotoxic drugs and who plan to become pregnantPatients who proposed cryopreservation of sperm
QI 1-6Female patients of childbearing age with SLE who are on fertility medications, have stable disease activity, aPL negative, and desire to have a babyPatient proposed assisted reproductive treatment if necessary
QI 1-7Female patients with SLE who have stable disease activity and undergo ovarian stimulationPatients continued on necessary and tolerable immunosuppressive medications
QI 1-8Obstetric and/or thrombotic APS female patientsPatients who avoided hormone replacement therapy in assisted reproductive medicine
QI 1-9Female patients with SLE planning pregnancyPatients in remission for at least 6 months prior to pregnancy
QI 1-10Female SLE patients with severe pulmonary hypertension*
*Estimated systolic PAP >50 mmHg or symptomatic
Patients explained contraception
QI 1-11Female SLE patients with severe constrictive lung disease*
*FVC <50% of predicted value
Patients explained contraception
QI 1-12Female patients with SLE with severe heart failure*
*WHO Class IV including severe ventricular dysfunction with LVEF <30% and NYHA Class III–IV
Patients explained contraception
QI 1-13Female patients with SLE with severe renal failure*
*Serum creatinine ≥ 2.8 mg/dl (500 mmol/l)
Patients explained contraception
QI 1-14Female patients with SLE who developed thrombosis within 6 monthsPatients explained contraception
QI 1-15Female patients with SLE who had a flare-up of lupus nephritisPatients explained contraception for 6 months after remission
QI 2-1Patients with SLE before and during the first trimester of pregnancyPatients tested for anti-SS-A/Ro and anti-SS-B/La antibodies
QI 2-2Patients with SLE before pregnancyPatients tested for aPL
QI 2-3Patients with SLE planning a pregnancyPatients with complete blood count and biochemistry, renal function parameters (urinalysis including sediment, urine protein/creatinine ratio), C3, C4, and double-stranded anti-DNA antibodies tested at the stage of planned pregnancy
QI 2-4Pregnant patients with SLE with lupus nephritis in remissionPatients with serum creatinine and urine protein-creatinine ratios tested at least every 4 weeks
QI 2-5Pregnant patients with SLE with lupus nephritisPatients who had blood pressure measurements and urinalysis every 4 weeks until 28 weeks’ gestation, every 2 weeks until 36 weeks, and then weekly thereafter until delivery
QI 2-6Pregnant patients with SLE positive for anti-SS-A/Ro and/or anti-SS-B/La antibodiesPatients tested for foetal echocardiography
QI 3-1Patients with SLE starting treatment with drugs that may affect gonadal functionPatients discussing pregnancy planning prior to drug initiation
QI 3-2Patient with SLE who discontinued teratogenic drugs prior to pregnancyPatients who have been observed without medication or transitioned to a drug that can be used during pregnancy
QI 3-3Female patient with SLE planning pregnancyPatients who discontinued MTX at least 1 month prior to pregnancy
QI 3-4Female patient with SLE planning pregnancyPatients who discontinued MMF at least 6 weeks prior to pregnancy
QI 3-5Female patient with SLE planning pregnancyPatients who discontinued CYC at least 3 months prior to pregnancy
QI 3-6Male patients with SLE who wish to become pregnantPatients who avoided receiving CYC
QI 3-7Male patients with SLE who are using HCQ and AZP and wish to become pregnantPatients who continued to use HCQ and AZP
QI 3-8Pregnant patients with SLE who have been inadvertently exposed to teratogenic agentsPatients referred immediately to a maternal foetal medicine specialist, a pregnancy pharmacotherapy specialist, or a genetics counsellor
QI 3-9Pregnant SLE patient with APSPatients treated with low-dose aspirin and heparin
QI 3-10Pregnant SLE patient with APSPatients who avoided using DOAC
QI 3-11Pregnant patients with SLEPatients who avoided the use of MMF, MTX, and CYC
QI 3-12Pregnant patients with SLE using HCQPatients who continued on HCQ during pregnancy
QI 3-13Female patients with SLE who is positive for anti-SS-A/Ro antibodies and has a history of congenital heart block in a previous childPatients using HCQ
QI 3-14Pregnant patients with SLEPatients who avoided the use of NSAIDs in the third trimester of pregnancy
QI 3-15Pregnant patients with SLEPatients who avoided using ARB
QI 3-16Pregnant patients with SLE on CyA and TACPatients monitored for blood pressure, renal function, and drug concentrations
QI 3-17Obstetric APS patientsPatients receiving prophylactic anticoagulation therapy during the first 6–12 weeks postpartum
QI 3-18Patients with SLE who are taking corticosteroids and who are breastfeedingPatients who continued to breastfeed
QI 3-19Patients with SLE who are using HCQ, AZP, TAC, or rituximab and who are breastfeedingPatients who continued to use HCQ, AZP, TAC, or rituximab
QI 3-20Patient with SLE who is breastfeedingPatients who avoided using CYC and MMF
Denominator of QINumerator of QI
QI 1-1Female patients with SLE planning for pregnancyPatients who consulted an obstetrician
QI 1-2Female patients of childbearing age with SLEPatients explaining the need for a planned pregnancy
QI 1-3Female patients of childbearing age with SLE who are aPL negative, have stable or low disease activity, have no desire to have a baby, and wish to use contraceptionPatients proposed effective contraceptive methods (e.g. hormonal contraceptives or intrauterine devices)
QI 1-4Female patients of childbearing age with SLE of moderate-to-severe disease activity, including nephritisPatients proposed to use progestin-only contraceptive pills or intrauterine device for contraception
QI 1-5Male patients with SLE who have not started treatment with gonadotoxic drugs and who plan to become pregnantPatients who proposed cryopreservation of sperm
QI 1-6Female patients of childbearing age with SLE who are on fertility medications, have stable disease activity, aPL negative, and desire to have a babyPatient proposed assisted reproductive treatment if necessary
QI 1-7Female patients with SLE who have stable disease activity and undergo ovarian stimulationPatients continued on necessary and tolerable immunosuppressive medications
QI 1-8Obstetric and/or thrombotic APS female patientsPatients who avoided hormone replacement therapy in assisted reproductive medicine
QI 1-9Female patients with SLE planning pregnancyPatients in remission for at least 6 months prior to pregnancy
QI 1-10Female SLE patients with severe pulmonary hypertension*
*Estimated systolic PAP >50 mmHg or symptomatic
Patients explained contraception
QI 1-11Female SLE patients with severe constrictive lung disease*
*FVC <50% of predicted value
Patients explained contraception
QI 1-12Female patients with SLE with severe heart failure*
*WHO Class IV including severe ventricular dysfunction with LVEF <30% and NYHA Class III–IV
Patients explained contraception
QI 1-13Female patients with SLE with severe renal failure*
*Serum creatinine ≥ 2.8 mg/dl (500 mmol/l)
Patients explained contraception
QI 1-14Female patients with SLE who developed thrombosis within 6 monthsPatients explained contraception
QI 1-15Female patients with SLE who had a flare-up of lupus nephritisPatients explained contraception for 6 months after remission
QI 2-1Patients with SLE before and during the first trimester of pregnancyPatients tested for anti-SS-A/Ro and anti-SS-B/La antibodies
QI 2-2Patients with SLE before pregnancyPatients tested for aPL
QI 2-3Patients with SLE planning a pregnancyPatients with complete blood count and biochemistry, renal function parameters (urinalysis including sediment, urine protein/creatinine ratio), C3, C4, and double-stranded anti-DNA antibodies tested at the stage of planned pregnancy
QI 2-4Pregnant patients with SLE with lupus nephritis in remissionPatients with serum creatinine and urine protein-creatinine ratios tested at least every 4 weeks
QI 2-5Pregnant patients with SLE with lupus nephritisPatients who had blood pressure measurements and urinalysis every 4 weeks until 28 weeks’ gestation, every 2 weeks until 36 weeks, and then weekly thereafter until delivery
QI 2-6Pregnant patients with SLE positive for anti-SS-A/Ro and/or anti-SS-B/La antibodiesPatients tested for foetal echocardiography
QI 3-1Patients with SLE starting treatment with drugs that may affect gonadal functionPatients discussing pregnancy planning prior to drug initiation
QI 3-2Patient with SLE who discontinued teratogenic drugs prior to pregnancyPatients who have been observed without medication or transitioned to a drug that can be used during pregnancy
QI 3-3Female patient with SLE planning pregnancyPatients who discontinued MTX at least 1 month prior to pregnancy
QI 3-4Female patient with SLE planning pregnancyPatients who discontinued MMF at least 6 weeks prior to pregnancy
QI 3-5Female patient with SLE planning pregnancyPatients who discontinued CYC at least 3 months prior to pregnancy
QI 3-6Male patients with SLE who wish to become pregnantPatients who avoided receiving CYC
QI 3-7Male patients with SLE who are using HCQ and AZP and wish to become pregnantPatients who continued to use HCQ and AZP
QI 3-8Pregnant patients with SLE who have been inadvertently exposed to teratogenic agentsPatients referred immediately to a maternal foetal medicine specialist, a pregnancy pharmacotherapy specialist, or a genetics counsellor
QI 3-9Pregnant SLE patient with APSPatients treated with low-dose aspirin and heparin
QI 3-10Pregnant SLE patient with APSPatients who avoided using DOAC
QI 3-11Pregnant patients with SLEPatients who avoided the use of MMF, MTX, and CYC
QI 3-12Pregnant patients with SLE using HCQPatients who continued on HCQ during pregnancy
QI 3-13Female patients with SLE who is positive for anti-SS-A/Ro antibodies and has a history of congenital heart block in a previous childPatients using HCQ
QI 3-14Pregnant patients with SLEPatients who avoided the use of NSAIDs in the third trimester of pregnancy
QI 3-15Pregnant patients with SLEPatients who avoided using ARB
QI 3-16Pregnant patients with SLE on CyA and TACPatients monitored for blood pressure, renal function, and drug concentrations
QI 3-17Obstetric APS patientsPatients receiving prophylactic anticoagulation therapy during the first 6–12 weeks postpartum
QI 3-18Patients with SLE who are taking corticosteroids and who are breastfeedingPatients who continued to breastfeed
QI 3-19Patients with SLE who are using HCQ, AZP, TAC, or rituximab and who are breastfeedingPatients who continued to use HCQ, AZP, TAC, or rituximab
QI 3-20Patient with SLE who is breastfeedingPatients who avoided using CYC and MMF

Abbreviations: PAP, pulmonary arterial pressure; FVC, forced vital capacity; LVEF, left ventricular ejection fraction; NYHA, New York Heart Association; MTX, methotrexate; MMF, mycophenolate mofetil; CYC, cyclophosphamide; HCQ, hydroxychloroquine; AZP, azathioprine; DOAC, direct oral anticoagulant; NSAIDs, non-steroidal anti-inflammatory drugs; ARB, angiotensin-II receptor blocker; CyA, cyclosporin A; TAC, tacrolimus; WHO, World Health Organization.

Table 1.

A QI set for pregnancy and childbirth in SLE patients.

Denominator of QINumerator of QI
QI 1-1Female patients with SLE planning for pregnancyPatients who consulted an obstetrician
QI 1-2Female patients of childbearing age with SLEPatients explaining the need for a planned pregnancy
QI 1-3Female patients of childbearing age with SLE who are aPL negative, have stable or low disease activity, have no desire to have a baby, and wish to use contraceptionPatients proposed effective contraceptive methods (e.g. hormonal contraceptives or intrauterine devices)
QI 1-4Female patients of childbearing age with SLE of moderate-to-severe disease activity, including nephritisPatients proposed to use progestin-only contraceptive pills or intrauterine device for contraception
QI 1-5Male patients with SLE who have not started treatment with gonadotoxic drugs and who plan to become pregnantPatients who proposed cryopreservation of sperm
QI 1-6Female patients of childbearing age with SLE who are on fertility medications, have stable disease activity, aPL negative, and desire to have a babyPatient proposed assisted reproductive treatment if necessary
QI 1-7Female patients with SLE who have stable disease activity and undergo ovarian stimulationPatients continued on necessary and tolerable immunosuppressive medications
QI 1-8Obstetric and/or thrombotic APS female patientsPatients who avoided hormone replacement therapy in assisted reproductive medicine
QI 1-9Female patients with SLE planning pregnancyPatients in remission for at least 6 months prior to pregnancy
QI 1-10Female SLE patients with severe pulmonary hypertension*
*Estimated systolic PAP >50 mmHg or symptomatic
Patients explained contraception
QI 1-11Female SLE patients with severe constrictive lung disease*
*FVC <50% of predicted value
Patients explained contraception
QI 1-12Female patients with SLE with severe heart failure*
*WHO Class IV including severe ventricular dysfunction with LVEF <30% and NYHA Class III–IV
Patients explained contraception
QI 1-13Female patients with SLE with severe renal failure*
*Serum creatinine ≥ 2.8 mg/dl (500 mmol/l)
Patients explained contraception
QI 1-14Female patients with SLE who developed thrombosis within 6 monthsPatients explained contraception
QI 1-15Female patients with SLE who had a flare-up of lupus nephritisPatients explained contraception for 6 months after remission
QI 2-1Patients with SLE before and during the first trimester of pregnancyPatients tested for anti-SS-A/Ro and anti-SS-B/La antibodies
QI 2-2Patients with SLE before pregnancyPatients tested for aPL
QI 2-3Patients with SLE planning a pregnancyPatients with complete blood count and biochemistry, renal function parameters (urinalysis including sediment, urine protein/creatinine ratio), C3, C4, and double-stranded anti-DNA antibodies tested at the stage of planned pregnancy
QI 2-4Pregnant patients with SLE with lupus nephritis in remissionPatients with serum creatinine and urine protein-creatinine ratios tested at least every 4 weeks
QI 2-5Pregnant patients with SLE with lupus nephritisPatients who had blood pressure measurements and urinalysis every 4 weeks until 28 weeks’ gestation, every 2 weeks until 36 weeks, and then weekly thereafter until delivery
QI 2-6Pregnant patients with SLE positive for anti-SS-A/Ro and/or anti-SS-B/La antibodiesPatients tested for foetal echocardiography
QI 3-1Patients with SLE starting treatment with drugs that may affect gonadal functionPatients discussing pregnancy planning prior to drug initiation
QI 3-2Patient with SLE who discontinued teratogenic drugs prior to pregnancyPatients who have been observed without medication or transitioned to a drug that can be used during pregnancy
QI 3-3Female patient with SLE planning pregnancyPatients who discontinued MTX at least 1 month prior to pregnancy
QI 3-4Female patient with SLE planning pregnancyPatients who discontinued MMF at least 6 weeks prior to pregnancy
QI 3-5Female patient with SLE planning pregnancyPatients who discontinued CYC at least 3 months prior to pregnancy
QI 3-6Male patients with SLE who wish to become pregnantPatients who avoided receiving CYC
QI 3-7Male patients with SLE who are using HCQ and AZP and wish to become pregnantPatients who continued to use HCQ and AZP
QI 3-8Pregnant patients with SLE who have been inadvertently exposed to teratogenic agentsPatients referred immediately to a maternal foetal medicine specialist, a pregnancy pharmacotherapy specialist, or a genetics counsellor
QI 3-9Pregnant SLE patient with APSPatients treated with low-dose aspirin and heparin
QI 3-10Pregnant SLE patient with APSPatients who avoided using DOAC
QI 3-11Pregnant patients with SLEPatients who avoided the use of MMF, MTX, and CYC
QI 3-12Pregnant patients with SLE using HCQPatients who continued on HCQ during pregnancy
QI 3-13Female patients with SLE who is positive for anti-SS-A/Ro antibodies and has a history of congenital heart block in a previous childPatients using HCQ
QI 3-14Pregnant patients with SLEPatients who avoided the use of NSAIDs in the third trimester of pregnancy
QI 3-15Pregnant patients with SLEPatients who avoided using ARB
QI 3-16Pregnant patients with SLE on CyA and TACPatients monitored for blood pressure, renal function, and drug concentrations
QI 3-17Obstetric APS patientsPatients receiving prophylactic anticoagulation therapy during the first 6–12 weeks postpartum
QI 3-18Patients with SLE who are taking corticosteroids and who are breastfeedingPatients who continued to breastfeed
QI 3-19Patients with SLE who are using HCQ, AZP, TAC, or rituximab and who are breastfeedingPatients who continued to use HCQ, AZP, TAC, or rituximab
QI 3-20Patient with SLE who is breastfeedingPatients who avoided using CYC and MMF
Denominator of QINumerator of QI
QI 1-1Female patients with SLE planning for pregnancyPatients who consulted an obstetrician
QI 1-2Female patients of childbearing age with SLEPatients explaining the need for a planned pregnancy
QI 1-3Female patients of childbearing age with SLE who are aPL negative, have stable or low disease activity, have no desire to have a baby, and wish to use contraceptionPatients proposed effective contraceptive methods (e.g. hormonal contraceptives or intrauterine devices)
QI 1-4Female patients of childbearing age with SLE of moderate-to-severe disease activity, including nephritisPatients proposed to use progestin-only contraceptive pills or intrauterine device for contraception
QI 1-5Male patients with SLE who have not started treatment with gonadotoxic drugs and who plan to become pregnantPatients who proposed cryopreservation of sperm
QI 1-6Female patients of childbearing age with SLE who are on fertility medications, have stable disease activity, aPL negative, and desire to have a babyPatient proposed assisted reproductive treatment if necessary
QI 1-7Female patients with SLE who have stable disease activity and undergo ovarian stimulationPatients continued on necessary and tolerable immunosuppressive medications
QI 1-8Obstetric and/or thrombotic APS female patientsPatients who avoided hormone replacement therapy in assisted reproductive medicine
QI 1-9Female patients with SLE planning pregnancyPatients in remission for at least 6 months prior to pregnancy
QI 1-10Female SLE patients with severe pulmonary hypertension*
*Estimated systolic PAP >50 mmHg or symptomatic
Patients explained contraception
QI 1-11Female SLE patients with severe constrictive lung disease*
*FVC <50% of predicted value
Patients explained contraception
QI 1-12Female patients with SLE with severe heart failure*
*WHO Class IV including severe ventricular dysfunction with LVEF <30% and NYHA Class III–IV
Patients explained contraception
QI 1-13Female patients with SLE with severe renal failure*
*Serum creatinine ≥ 2.8 mg/dl (500 mmol/l)
Patients explained contraception
QI 1-14Female patients with SLE who developed thrombosis within 6 monthsPatients explained contraception
QI 1-15Female patients with SLE who had a flare-up of lupus nephritisPatients explained contraception for 6 months after remission
QI 2-1Patients with SLE before and during the first trimester of pregnancyPatients tested for anti-SS-A/Ro and anti-SS-B/La antibodies
QI 2-2Patients with SLE before pregnancyPatients tested for aPL
QI 2-3Patients with SLE planning a pregnancyPatients with complete blood count and biochemistry, renal function parameters (urinalysis including sediment, urine protein/creatinine ratio), C3, C4, and double-stranded anti-DNA antibodies tested at the stage of planned pregnancy
QI 2-4Pregnant patients with SLE with lupus nephritis in remissionPatients with serum creatinine and urine protein-creatinine ratios tested at least every 4 weeks
QI 2-5Pregnant patients with SLE with lupus nephritisPatients who had blood pressure measurements and urinalysis every 4 weeks until 28 weeks’ gestation, every 2 weeks until 36 weeks, and then weekly thereafter until delivery
QI 2-6Pregnant patients with SLE positive for anti-SS-A/Ro and/or anti-SS-B/La antibodiesPatients tested for foetal echocardiography
QI 3-1Patients with SLE starting treatment with drugs that may affect gonadal functionPatients discussing pregnancy planning prior to drug initiation
QI 3-2Patient with SLE who discontinued teratogenic drugs prior to pregnancyPatients who have been observed without medication or transitioned to a drug that can be used during pregnancy
QI 3-3Female patient with SLE planning pregnancyPatients who discontinued MTX at least 1 month prior to pregnancy
QI 3-4Female patient with SLE planning pregnancyPatients who discontinued MMF at least 6 weeks prior to pregnancy
QI 3-5Female patient with SLE planning pregnancyPatients who discontinued CYC at least 3 months prior to pregnancy
QI 3-6Male patients with SLE who wish to become pregnantPatients who avoided receiving CYC
QI 3-7Male patients with SLE who are using HCQ and AZP and wish to become pregnantPatients who continued to use HCQ and AZP
QI 3-8Pregnant patients with SLE who have been inadvertently exposed to teratogenic agentsPatients referred immediately to a maternal foetal medicine specialist, a pregnancy pharmacotherapy specialist, or a genetics counsellor
QI 3-9Pregnant SLE patient with APSPatients treated with low-dose aspirin and heparin
QI 3-10Pregnant SLE patient with APSPatients who avoided using DOAC
QI 3-11Pregnant patients with SLEPatients who avoided the use of MMF, MTX, and CYC
QI 3-12Pregnant patients with SLE using HCQPatients who continued on HCQ during pregnancy
QI 3-13Female patients with SLE who is positive for anti-SS-A/Ro antibodies and has a history of congenital heart block in a previous childPatients using HCQ
QI 3-14Pregnant patients with SLEPatients who avoided the use of NSAIDs in the third trimester of pregnancy
QI 3-15Pregnant patients with SLEPatients who avoided using ARB
QI 3-16Pregnant patients with SLE on CyA and TACPatients monitored for blood pressure, renal function, and drug concentrations
QI 3-17Obstetric APS patientsPatients receiving prophylactic anticoagulation therapy during the first 6–12 weeks postpartum
QI 3-18Patients with SLE who are taking corticosteroids and who are breastfeedingPatients who continued to breastfeed
QI 3-19Patients with SLE who are using HCQ, AZP, TAC, or rituximab and who are breastfeedingPatients who continued to use HCQ, AZP, TAC, or rituximab
QI 3-20Patient with SLE who is breastfeedingPatients who avoided using CYC and MMF

Abbreviations: PAP, pulmonary arterial pressure; FVC, forced vital capacity; LVEF, left ventricular ejection fraction; NYHA, New York Heart Association; MTX, methotrexate; MMF, mycophenolate mofetil; CYC, cyclophosphamide; HCQ, hydroxychloroquine; AZP, azathioprine; DOAC, direct oral anticoagulant; NSAIDs, non-steroidal anti-inflammatory drugs; ARB, angiotensin-II receptor blocker; CyA, cyclosporin A; TAC, tacrolimus; WHO, World Health Organization.

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