Chronic renal insufficiency in pregnancy

This article attempts to assess the nature, severity and management of the risks associated with pregnancy in chronic renal insufficiency and end-stage renal disease, including dialysis and transplant recipients. Women with serum creatinine levels of >125 mmol/l are at an increased risk for deterioration in renal function, hypertension with superimposed pre-eclampsia and obstetric complications. Rigid control of hypertension is crucial for a successful pregnancy outcome. A range of antihypertensive drugs are available with angiotensin converting enzyme inhibitors being contraindicated. Women on dialysis have low fertility rates that return to normal following renal transplantation. Immunosuppresive drugs are not associated with increased congenital anomalies. Transplant recipients are at an increased risk for infections that may have implications for the fetus. All groups have an increased risk for prematurity and intrauterine growth restriction. The percentage of pregnancies resulting in surviving infants in women with renal insufficiency and transplant recipients ranges from 80-100%. For women who conceive after dialysis, the likelihood of a surviving infant is approximately 50%

Factors affecting fertility following radical versus conservative surgical treatment for tubal pregnancy

The aim of this study was to analyze the fertility prognosis after conservative or radical surgery for ectopic pregnancy. Also, to identify any biological factors that may influence the fertility outcome after an ectopic pregnancy. A retrospective study which was carried out by collating information from the patient's hospital records was performed on 137 cases of confirmed ectopic pregnancy between January 1990 and December 1995 at the Security Forces Hospital Riyadh, Kingdom of Saudi Arabia. The outcome measure of term pregnancy rate and repeat ectopic pregnancy rate was analyzed up to 3 years after the diagnosis of index ectopic pregnancy. Our results showed that the term pregnancy rates were not significantly different following radical or conservative surgical treatments for ectopic pregnancy, P >0.05, [50% in the conservative group compared with 56% in the radical group]. But equally important, the risk of a further ectopic was not increased in the radical surgery group, P >0.05 [11% in the conservative group as compared to 8% in the radical group]. The incidence of intrauterine pregnancy rate [term pregnancy + miscarriage] was also comparable in each group. Multivariate regression analysis showed that the factors associated with higher fertility were age 30 years or less, past history of term pregnancy and a negative history of infertility [P <0.05]. No significant difference in intrauterine pregnancy rates or repeat ectopic pregnancy rates were found after radical or conservative surgical treatment for tubal pregnancy. The patient's age, previous obstetric performance and a history of infertility significantly influenced fertility following the index ectopic pregnancy