ABSTRACT
AIM: To describe pregnancy outcome of kidney transplant patients till 1 year postpartum. METHODS: This retrospective, monocentric study included 15 kidney transplant patients who presented 18 pregnancies, between January 2000 and January 2020. For each of them, we searched for possible obstetrical, fetal and renal complications and we evaluated renal function before, during and after pregnancy. RESULTS: The live birth rate was 84% (16/19) with an average gestational age at delivery of 37 weeks of gestation. The rate of prematurity was 50% (8/16), gestational diabetes was 16.6% (3/18) and preeclampsia was 27.7% (5/18). Cesarean section was performed in 61.1% (11/18) of cases including, 81.8% (9/11) unplanned surgery. The average birth weight was 2635 grams and 37.5% (6/16) of the newborn were small for gestational age. All patients had stable renal function before conception of pregnancy. We noticed two acute graft rejection during pregnancy with only one resulting in graft loss. Four patients had a reduced graft function in 12months of the postpartum. CONCLUSION: Risk of maternal, fetal and renal complications remained high in kidney transplant recipients. Pregnancy should be carefully planned in transplanted women associated with adequate follow-up according to clinical guidelines (normal renal function and blood pressure without proteinuria before pregnancy, no recent graft rejection, period of one year after transplant respected and no teratogenic treatment in the month before pregnancy).
Subject(s)
Cesarean Section , Kidney Transplantation , Pregnancy Complications , Pregnancy Outcome , Humans , Female , Pregnancy , Retrospective Studies , Adult , Pregnancy Complications/epidemiology , Cesarean Section/statistics & numerical data , Infant, Newborn , Hospitals, Maternity , Pre-Eclampsia/epidemiology , Graft Rejection/epidemiology , Gestational Age , Diabetes, Gestational/epidemiology , Birth Weight , Live BirthABSTRACT
The most typical condition of the liver in pregnancy is intrahepatic cholestasis of pregnancy (ICP). There is the occurrence of itching/pruritus together with a decline in liver function tests (LFTs) and frequently higher blood levels of total bile acids, which are used to make the diagnosis. ICP often shows symptoms during the third term of pregnancy and sometimes in the second term. After delivery, the disease's symptoms disappear on their own. It is still unclear what causes this disorder. It constitutes a hazard for the infant and is exceedingly stressful for the mother. Although relatively harmless for the expectant mother, ICP poses a significant risk to the unborn child. Preterm birth, meconium excreted in the amniotic fluid, respiratory distress syndrome, foetal distress and abrupt intrauterine foetal death are all risks seen in this disorder. It is still challenging to identify foetuses who are at risk for ICP issues. There needs to be a clear consensus on the best obstetrical care for ICPs. This review is done to brief the research on the foetal consequences of ICP and to discuss treatment strategies for its avoidance. Serum alanine transaminase, aspartate transaminase, total bilirubin, alkaline phosphatase, albumin, direct bilirubin, total protein, and total bile acids were among the biochemical predictors. Blood tests that confirm obstetric cholestasis should alter the course of treatment. Ursodeoxycholic acid may be prescribed to affected individuals to cure itching and prevent the build-up of biliary components of maternal origin in the baby, which may increase the danger of foetal discomfort and stillbirth.
ABSTRACT
Introduction: Multiple and specifically monochorionic diamniotic (MCDA) pregnancies are related to maternal and foetal complications. The aim of this study is to evaluate obstetric and perinatal outcomes of MCDA after assisted reproductive techniques (ART). Methods: This is a case-control study comparing 23 MCDA twin pregnancies after ART (ART-MCDA) and 75 spontaneous MCDA (sMCDA). Maternal, obstetric, foetal, and perinatal outcomes variables including maternal age, prematurity, TTTS, sIUGR, TAPS, PROM, and neonatal weight were compared. Results: mean maternal age is higher in the ART-MCDA pregnancies, 38.0±.6 (OR=1.32(1.131.53)). Neonates weighing between 1500 and 2500g are more frequent in the sMCDA group and those weighing >2500g in the ART group (OR=0.47(0.220.97)). Foetuses born at between 32 and 37 weeks are more frequent in sMCDA pregnancies and those born >37 in the TRA group (OR=0.27(0.090.80)). These differences are lost when we adjust the results by maternal age. There were no differences in maternal, obstetric, or foetal complications. Conclusions: ART-MCDA are not associated with a higher number of maternal, obstetric or foetal complications if they are adjusted by maternal age. When they are not adjusted by maternal age, there would be better outcomes such as premature and neonatal weight in the ART group.(AU)
Antecedentes: El incremento de las técnicas de reproducción asistida (TRA) ha supuesto un aumento de las gestaciones gemelares en general, pero también de las monocoriales biamnióticas (MCBA), que se asocian a diversas complicaciones maternofetales. Estas complicaciones están bien estudiadas en gestaciones espontáneas, pero no en aquellas conseguidas mediante una TRA. Objetivo: Comparar la incidencia de complicaciones maternas, fetales, obstétricas y perinatales en gestaciones MCBA conseguidas de forma espontánea frente a aquellas conseguidas mediante TRA. Materiales y métodos: Estudio de casos-controles retrospectivo. Se han analizado 98 gestaciones gemelares MCBA controladas en la Unidad de Medicina Materno-Fetal del Servicio de Obstetricia del Hospital La Paz de Madrid entre los años 2015 y 2020. Resultados: La media de edad de las madres de las gestaciones MCBA conseguidas mediante TRA es mayor (OR=1,32 [1,13-1,53]). Los recién nacidos de peso entre 1.500-2.500g son más frecuentes en las gestaciones MCBA conseguidas de forma espontánea y los de >2.500g en las de TRA (OR=0,47 [0,220,97]). Los recién nacidos entre las 32-37 semanas son más frecuentes en las gestaciones gemelares MCBA espontáneas y los recién nacidos de >37 semanas en las de TRA (OR=0,27 [0,09-0,80]). Cuando estos resultados se ajustan por la edad materna dejan de ser estadísticamente significativos. Conclusiones: Las TRA no conllevan un aumento de las complicaciones en las gestaciones MCBA cuando se ajustan los resultados por la edad materna. Si no se ajustasen por la edad materna, las gestaciones MCBA conseguidas mediante TRA tendrían mejores resultados, con menos prematuridad y mayor peso del neonato.(AU)
Subject(s)
Humans , Female , Reproductive Techniques , TwinsABSTRACT
OBJECTIVE: To estimate the annual cost associated with obstetric events in women of reproductive age with immune-mediated inflammatory diseases, from the perspective of the National Healthcare System. METHODS: A cost-analysis was developed to estimate the impact associated with obstetric events in women of reproductive age with psoriasis (PSO), psoriatic arthritis (PsA), rheumatoid arthritis (RA) and axial spondyloarthritis (axSpA). The analysis considered complications during fertility and conception, in pregnancy and in the postpartum. All parameters were validated and agreed by a multidisciplinary expert panel. Unitary costs (,2019) were obtained from national, local databases. RESULTS: During fertility and conception, an annual cost per patient of 229 was estimated for a preconception consultation in a patient with PSO, of 3642 for a preconception consultation in patients with PsA, RA and axSpA and 4339 for assisted reproduction. Women with complications in pregnancy had an annual cost per patient of 1214 for a miscarriage in the first trimester, 4419 for a late miscarriage in the second trimester, 11,260 for preeclampsia 3188 for restricted intrauterine growth and 12,131 for threat of premature delivery. In the postpartum, an annual cost per patient of 120,364, 44,709, and 5507 were estimated associated with admissions to neonatology of premature infants of <28, 28-32 and 33-37 weeks, respectively. CONCLUSIONS: This analysis provides insight on the economic burden of complications associated with women of reproductive age for immune-mediated diseases (PSO, PsA, RA, axSpA). Individualization of treatment, additional and close monitoring may reduce the risk and burden of these complications.
Subject(s)
Arthritis, Psoriatic , Arthritis, Rheumatoid , Axial Spondyloarthritis , Psoriasis , Arthritis, Psoriatic/epidemiology , Arthritis, Rheumatoid/epidemiology , Female , Humans , Pregnancy , Reproduction , Spain/epidemiologyABSTRACT
Objetivo: Estimar el coste anual asociado a eventos obstétricos que pueden experimentar mujeres en edad fértil con enfermedades inflamatorias inmunomediadas, desde la perspectiva del Sistema Nacional de Salud. Métodos: Se desarrolló un análisis de costes para estimar el impacto anual por paciente asociado a eventos obstétricos en mujeres en edad reproductiva con artritis psoriásica (APs), artritis reumatoide (AR), espondiloartritis axial (EspAax) y psoriasis (PsO). Se consideraron eventos durante la fertilidad, la concepción, el embarazo y el posparto. Todos los parámetros fueron validados y consensuados por un panel multidisciplinar de expertos. Los costes unitarios (, 2019) se obtuvieron de bases de datos nacionales. Resultados: Durante la fertilidad y concepción, se estimó un coste anual/paciente de 229 para una consulta preconcepcional en pacientes con PsO, de 3.642 en pacientes con APs, AR y EspAax y de 4.339 para reproducción asistida. En el embarazo, el coste anual/paciente fue de 1.214 para un aborto espontáneo en el 1.er trimestre, 4.419 para un aborto tardío en el 2.o trimestre, 11.260 para preeclampsia, 3.188 para crecimiento intrauterino retardado y 12.131 para amenaza de parto prematuro. En el posparto, se estimó un coste anual/paciente de 120.364, 44.709 y 5.507 para prematuridad de<28, 28-32 y 33-37 semanas, respectivamente. Conclusiones: Este análisis facilita información sobre la carga económica de los eventos en mujeres en edad reproductiva con APs, AR, EspAax y PsO. Una adecuada planificación junto con la individualización del manejo, el tratamiento y la monitorización adicional pueden reducir el riesgo y la carga de estos eventos.(AU)
Objective: To estimate the annual cost associated with obstetric events in women of reproductive age with immune-mediated inflammatory diseases, from the perspective of the National Healthcare System. Methods: A cost-analysis was developed to estimate the impact associated with obstetric events in women of reproductive age with psoriasis (PSO), psoriatic arthritis (PsA), rheumatoid arthritis (RA) and axial spondyloarthritis (axSpA). The analysis considered complications during fertility and conception, in pregnancy and in the postpartum. All parameters were validated and agreed by a multidisciplinary expert panel. Unitary costs (, 2019) were obtained from national, local databases. Results: During fertility and conception, an annual cost per patient of 229 was estimated for a preconception consultation in a patient with PSO, of 3,642 for a preconception consultation in patients with PsA, RA and axSpA and 4,339 for assisted reproduction. Women with complications in pregnancy had an annual cost per patient of 1,214 for a miscarriage in the first trimester, 4,419 for a late miscarriage in the second trimester, 11,260 for preeclampsia 3,188 for restricted intrauterine growth and 12,131 for threat of premature delivery. In the postpartum, an annual cost per patient of 120,364, 44,709, and 5,507 were estimated associated with admissions to neonatology of premature infants of <28, 28-32 and 33-37 weeks, respectively. Conclusions: This analysis provides insight on the economic burden of complications associated with women of reproductive age for immune-mediated diseases (PSO, PsA, RA, axSpA). Individualization of treatment, additional and close monitoring may reduce the risk and burden of these complications.(AU)
Subject(s)
Humans , Female , Arthritis, Psoriatic , Arthritis, Rheumatoid , Spondylarthritis , Spain , Psoriasis , Health Care Costs , Cost Savings , Obstetrics , Fertility , Fertilization , RheumatologyABSTRACT
OBJECTIVE: To estimate the annual cost associated with obstetric events in women of reproductive age with immune-mediated inflammatory diseases, from the perspective of the National Healthcare System. METHODS: A cost-analysis was developed to estimate the impact associated with obstetric events in women of reproductive age with psoriasis (PSO), psoriatic arthritis (PsA), rheumatoid arthritis (RA) and axial spondyloarthritis (axSpA). The analysis considered complications during fertility and conception, in pregnancy and in the postpartum. All parameters were validated and agreed by a multidisciplinary expert panel. Unitary costs (, 2019) were obtained from national, local databases. RESULTS: During fertility and conception, an annual cost per patient of 229 was estimated for a preconception consultation in a patient with PSO, of 3,642 for a preconception consultation in patients with PsA, RA and axSpA and 4,339 for assisted reproduction. Women with complications in pregnancy had an annual cost per patient of 1,214 for a miscarriage in the first trimester, 4,419 for a late miscarriage in the second trimester, 11,260 for preeclampsia 3,188 for restricted intrauterine growth and 12,131 for threat of premature delivery. In the postpartum, an annual cost per patient of 120,364, 44,709, and 5,507 were estimated associated with admissions to neonatology of premature infants of <28, 28-32 and 33-37 weeks, respectively. CONCLUSIONS: This analysis provides insight on the economic burden of complications associated with women of reproductive age for immune-mediated diseases (PSO, PsA, RA, axSpA). Individualization of treatment, additional and close monitoring may reduce the risk and burden of these complications.
ABSTRACT
While the management of pregnant patients with systemic lupus erythematosus (SLE) has improved over the last decades, the risk of maternal, foetal, and neonatal complications is still substantial. We evaluated the occurrence of adverse pregnancy outcomes (APO) occurring in 2002-2018 among patients with SLE from the catchment area of the Department of Rheumatology in Lund, Sweden. Longitudinal clinical and laboratory data were collected and analysed. Results were stratified according to the sequence of conception. We investigated a total of 59 pregnancies in 28 patients. Prior lupus nephritis was the clinical feature that, in a multivariable regression analysis, displayed the strongest association with APO overall (OR 6.0, p = 0.02). SLE combined with antiphospholipid syndrome (APS) was associated with the risk of miscarriage (OR 3.3, p = 0.04). The positivity of multiple antiphospholipid antibodies (aPL) was associated with APO overall (OR 3.3, p = 0.05). IgG anti-cardiolipin during pregnancy resulted in a higher risk of preterm delivery (OR 6.8, p = 0.03). Hypocomplementaemia was associated with several APO, but only in the first pregnancies. We conclude that, despite the close follow-up provided, a majority of pregnancies resulted in ≥1 APO, but a few of them were severe. Our study confirms the importance of previous lupus nephritis as a main risk factor for APO in patients with SLE.
ABSTRACT
BACKGROUND: Adolescent deliveries (10-19 years) carry a high risk of adverse outcomes due to the biological and physiological immaturity of these mothers. They pose a significant health burden in Cameroon, as it is reported that a high proportion of women attending delivery services are teenagers. We therefore sought to systematically assess the prevalence of adolescent deliveries in the country and its maternal and neonatal outcomes. METHODS: This was a systematic review of literature and a meta-analysis. We searched MEDLINE, CINAHL and Global Health online databases for all studies that reported the proportion of adolescent women who presented for delivery in health facilities in Cameroon. All observational studies published up to 10th July 2019, were included. RESULTS: A total of 47 articles were identified by the search. After removal of duplicates and screening of the titles and abstracts, 11 eligible studies were retained with ten articles meeting the inclusion criteria. These ten studies finally retained reported on nine different cohorts with a total of 99,653 women. The pooled prevalence of adolescent deliveries from the nine cohorts in Cameroon was 14.4% (95% CI: 10.7-18.6%), the prevalence for early adolescent deliveries was 2.8% (95% CI: 0.4-7.2%), meanwhile that for late adolescent deliveries was 12.5% (95% CI: 6.7-19.8%). The prevalence of adolescent deliveries in urban areas - 13.1% (95% CI: 7.8-19.6%) was similar to that in semi-urban areas- 14.1% (95% CI: 6.7-23.5%). Adolescents were more likely than adults (> 19 years) to have low birth weight babies (OR: 1.8; 95% CI: 1.6, 2.1); babies born with asphyxia (OR: 1.7; 95% CI: 1.3, 2.1); babies born before term (OR: 1.5; 95% CI: 1.1, 1.9) and babies who die in the neonatal period (OR: 2.1; 95% CI: 1.2, 3.8). CONCLUSION: The prevalence of adolescent deliveries in Cameroon is high. Implementation of adolescent-friendly policies is necessary to reduce the proportion of adolescents who become pregnant in Cameroon.
ABSTRACT
BACKGROUND: Caesarean section (CS) is usually perceived as a simple and safe alternative to natural birth, but in some instances can be technically difficult with consequent health hazards for both the mother and the fetus. We have proposed an evidence-based literature review of the most common difficult CS scenarios, with the aim to provide useful information about their management, possible prevention and resolution of complications. METHODS: We identified articles through a reserch in PubMed, Scopus, Web of Science and Ovid MEDLINE for studies published between 1979 and 2019. We included the best available evidence, such as RCTs, non-randomised controlled clinical trials, case-control studies, cohort studies, and case series. About sixty articles were included in this review, four hundred and thirty-six were excluded after reviewing the title or abstract or because they weren't in English. FINDINGS: The possible causes of "difficult" caesarean sections were divided into four categories: difficult access to the lower uterine segment; complicated fetal extraction, laceration or organ damage and abnormal placentation. CONCLUSIONS: Knowing in advance the potential technical difï¬culties and resulting risks allows the surgeon to plan appropriate strategies.
Subject(s)
Cesarean Section/methods , Intraoperative Complications/prevention & control , Cesarean Section, Repeat , Female , Humans , Iatrogenic Disease , Intestines/injuries , Intraoperative Complications/surgery , Labor Presentation , Leiomyoma , Obesity, Maternal , Placenta Accreta , Placenta Previa , Pregnancy , Pregnancy Complications, Neoplastic , Tissue Adhesions , Ureter/injuries , Urinary Bladder/injuries , Uterine NeoplasmsABSTRACT
Diabetes in pregnancy starts affecting the foetus even in the pre-conception period. The complications encountered in third trimester are foetal macrosomia and intrauterine foetal demise; birth of a macrosomic baby further leads to shoulder dystocia, birth trauma, brachial plexus injury. Additionally, pregnancies with overt/pregestational diabetes may be complicated with foetal growth restriction, congenital abnormalities diagnosed in third trimester and foetal hypertrophic obstructive cardiomyopathy. Even minor degrees of hyperglycaemia is associated with adverse pregnancy outcome. Optimizing maternal glycaemic control and foetal surveillance is crucial for optimizing the perinatal outcome and minimizing aforesaid complications. The management of macrosomia is controversial regarding timing and mode of delivery, but most authorities agree for primary caesarean if estimated foetal weight at the end of pregnancy is 4500 gram or more.
