*4.14. Gynaecological and Obstetrical Manifestations*

pSS does not have a negative impact on fertility, but chronic pain and vaginal dryness can be the cause of dyspareunia having a negative impact on the sexuality of female patients [244]. During pregnancy, pSS can be responsible for two rare but classic manifestations: autoimmune congenital heart block and neonatal lupus [245–247]. These two manifestations are linked to the transplacental passage of anti-Ro/SSA autoantibodies. Congenital heart block occurs in 2% of anti-Ro/SSA positive pregnancies but with a 10 to 20% risk of recurrence in subsequent pregnancies. More rarely, neonatal lupus can be associated with endocardial fibroelastosis, valvular malformations or septal defects. Neonatal lupus—affecting one fifth of anti-Ro/SSA positive pregnancies—is characterized by an erythematous rash and photosensitivity that can be associated with hepatic, haematological and neurological involvement. Compared with healthy pregnancy, patients with pSS had significantly higher chance of pregnancy loss or neonatal death. However, there were no significant associations between pSS and premature birth, spontaneous or artificial abortion or stillbirth [248]. These data should be taken with caution because they are based on a limited number of heterogeneous—and not necessarily recent—studies.

#### **5. Diagnosis Workup**
