Analysis of the perinatal outcome and risk factors for pregnancies complicated with chronic renal diseases / 中华妇产科杂志

ABSTRACT

Objective To investigate the perinatal outcome for pregnancies complicated with chronic renal diseases,and the risk factors for the adverse outcome.Methods Retrospectively analyze the clinical data of 48 patients with chronic renal diseases complicating pregnancy admitted in Peking University People's Hospital between January 1998 and August 2010,record the pregnancy outcome and explore the risk factors for the poor outcome using multivariate regression analysis.Results Thirty-eight patients had known chronic renal disease before conception,and ten were diagnosed during pregnancy.Seven patients (15％,7/48 ) presented with obvious renal impairment [ serum creatinine (sCr) ≥ 125 μmol/L] prepregnancy,and nine (19％,9/48 ) were recorded with chronic hypertension.Thirty-three patients received regular prenatal care.Twenty-one cases ( 44％,21/48 ) developed preeclampsia.During the gestation,normal renal function (defined as sCr ＜71 μmol/L) was seen in nineteen cases (40％,19/48),mild dysfunction (sCr ranged 71 - 132 μmol/L) in twenty (42％,20/48) and moderate to severe dysfunction ( sCr ≥ 132 μmol/L) in nine cases ( 19％,9/48 ).Twenty patients had negative or mild proteinuria (24 hour urine protein ＜2000 mg),19 had moderate (24 hour urine protein ranged 2000 -5000 mg) and nine had severe proteinuria (24 hour urine protein ≥ 5000 mg).The gestational age at delivery ranged from 24 to 41 weeks and the neonatal birth weight ranged from 890 to 4150 g.A total of twenty patients (42％,20/48 ) suffered adverse perinatal outcome,including one case with late spontaneous abortion,fifteen with preterm delivery,eleven with small for gestational age,two with neonatal respiratory distress syndrome and four with perinatal death.Declined maternal renal function was seen in eight patients,and two patients progressed toward the end-stage renal failure ( the stage of uremia).Multivariate regression analysis identified that preeclampsia (OR =24.72, P =0.002 ) and the degree of proteinuria ( OR =4.24,P =0.032) were the independent risk factors for the adverse perinatal outcome. Conclusions Pregnancies complicated with chronic renal diseases have significantly high incidence of preeclampsia and adverse perinatal outcome.Preeclampsia and the degree of proteinuria are perhaps the independent risk factors for the adverse outcome.