In Vitro Fertilization and Pregnancy Outcomes Among Patients After Kidney Transplantation: Case Series and Single-Center Experience.

INTRODUCTION: Kidney transplantation (KTx) is the treatment of choice in patients with end-stage renal failure. Among various medical issues in female graft recipients, the need for maternity can become an overriding one. Gonadal dysfunction usually resolves within 6 months after transplantation; however, the prevalence of infertility is similar to this in the general population. MATERIALS AND METHODS: This case series describes the experience in infertility treatment and following perinatal care among KTx women who underwent successful in vitro fertilization (IVF). We followed three patients who previously received KTx and underwent IVF between 2014 and 2015. The 34-year-old (patient A) and 39-year-old (patient B) women received single KTx, and the 31-year-old (patient C) woman had received three previous transplantations. Patients A and C were diagnosed with primary tubal factor infertility, while patient B suffered from secondary idiopathic infertility. The stimulation protocols had no influence on their general condition nor graft function. Viable singleton pregnancies were confirmed in all cases. All newborns were born preterm, via cesarean section, as a consequence of severe preeclampsia. Patients A and C gave birth at 34th week of gestation (WG) (A: 1810 g and C: 2295 g), while patient B gave birth at 36th WG (2655 g). Other pregnancy complications were intrauterine growth restriction (patient A) and gestational diabetes mellitus (patient B). Although mild graft dysfunction was observed prior to delivery, all clinical measures and hypertension resolved during the puerperium. CONCLUSIONS: In these cases, pregnancy after KTx did not implicate persistent graft dysfunction. Regardless of the method of conception, pregnancy following KTx is associated with an increased incidence of complications, therefore it requires a multidisciplinary approach. IVF itself seems to be a safe procedure in KTx recipients if the pregnancy is advisable.

Contraception in women after organ transplantation.

INTRODUCTION: Organ transplantation has improved the quality and length of life for many people suffering from end-stage diseases, among them women of reproductive age. Therefore, it has made pregnancy possible for those previously unable to conceive. Nevertheless, conception itself should be desired and properly timed in these specific patients to ensure the best possible perinatal outcome. OBJECTIVE: The objective of the study was to assess whether female graft recipients apply proper family planning methods and use effective contraception. METHODS: In a single-center, observational study, information was collected using a self-administered questionnaire distributed among 100 female graft recipients (post-transplant group [TG]) and 67 healthy female volunteers (control group [CG]). The survey covered data regarding present menstrual patterns, sexual activity, gynecological counseling, and contraceptive methods used. RESULTS: Female graft recipients were more sexually active after than before transplantation (87% vs 64%, P = .0001) and equally active as controls. Sexually active post-transplantation patients used contraception less frequently than sexually active controls (51.72% vs 82.76%, P < .0001). Condoms were the most frequently used method in TG, and oral contraception in CG. Oral contraception was used more rarely by counseled graft recipients than by counseled controls (3.9% vs 60.7%, P < .0001). After counseling, intrauterine device usage increased and oral contraception usage decreased in TG. Among women with chronic diseases, intrauterine device was used more often in TG (4% vs 0%), whereas oral contraception was used more often in CG (8.3% vs 50%, P < .0001). CONCLUSIONS: Despite the fact that post-transplantation women of reproductive age have many indications for highly effective contraception, only few of them actually use it. Contraceptive counseling has to be included as part of routine post-transplantation care by all health professionals involved in the management of female graft recipients of reproductive age.

Evaluation of selected markers of the immune system in children of renal transplant recipients.

OBJECTIVE: The aim of this study was to evaluate whether chronic use of immunosuppressive drugs during pregnancy in women after renal transplantation affects the concentration of immunoglobulin G (IgG) and IgM in the serum of their children. MATERIAL: Seventy-eight children aged 1 day to 15 years were enrolled. The study group consisted of 39 children born to renal transplant recipient mothers. The control group comprised 39 children whose mothers had not received immunosuppressive medications during pregnancy and were born at similar gestational age. METHODS: Serum concentrations of IgG and IgM were evaluated with the use of agglutination immunoassays on Siemens or Cobas device. Age-adjusted reference values for immunoglobulins formulated by Wolska-Kusnierz et al were used. Statistical analysis was performed with the use of Statistica 10.0 software with P value <.05 considered significant. RESULTS: Normal IgG concentrations were found in 82.05% (32) of children from the study group and 79.49% (31) of the control group. IgG concentrations below normal range were observed in 12.82% (5) of children from the study group and in 15.38% (6) of the control group. Normal concentrations of IgM were found in 53.85% (21) of children from the study group and in 61.54% (24) of the control group. Decreased levels of IgM were observed in 38.46% (15) of children from the study group and 35.9% (14) of the control group. There were no significant differences regarding the analyzed values between the groups. CONCLUSION: The exposure to chronic intrauterine immunosuppression had no significant effect on the concentration of IgG or IgM in children born to kidney transplant recipients.

[Patient's preferences concerning the course of labor]. / Preferencje kobiet dotyczace przebiegu porodu.

OBJECTIVE: Much concern is being focused on the improvement of perinatal care standards in recent time. Not only the safety of woman and newborn, but also the comfort and individual preferences should to be considered. The aim of this study was to assess of expectations and requirements of the delivering women in relation to the course of labor and usage of the most common procedures in clinical practice. MATERIAL AND METHODS: 47 women who delivered in Obstetrical Word in Puck were questionnaire. Mean gestational age was 39 +/- 1.5 hbd. 47% of women were nulliparous, 53% were multiparous. The following variables were analyzed: the presence of medical staff and family at delivery, possibility of the delivery position choice, use of auxiliary devices, a friendly atmosphere during delivery, use of analgesia and labor induction, episiotomy and ante-partum preparation, cesarean section on request, attendance to labor school. Mann-Whitney, Pearson and Yule tests were used for statistical analysis. RESULTS: 25% of women, mainly younger gravidae, attended the labor school. The midwife was considered the most important person at delivery. The presence of family member(s) was important for highly-educated women. The possibility to choose the delivery position and to walk during the 1st stage of labor was important for 73% of respondents. The majority of women who had attended the labor school avoided the horizontal position. Over 60% of patients accepted the usage of labor induction. A vast majority of women were against antepartum perineal shaving and episiotomy. Better-educated women preferred water delivery. 69% of the studied women would like to listen to the music at the delivery room. Cesarean section on request was supported by 11% of women. CONCLUSIONS: The tendency to promote modern delivery methods and active participation in labor leading is noticed. The significant influence of labor school on women's knowledge and their preferences was found.