Romero AJF, Ayala MJA, Jiménez SG

Language: Spanish
References: 17
Page: 643-651
PDF size: 273.64 Kb.

ABSTRACT

Background: Preeclampsia is a multisystemic syndrome with unknown etiology and characterized by abnormal vascular placentation response. Patients with renal transplantation restore them fertility 10 months after the intervention.
Objective: To evaluate incidence of preeclampsia and maternal-perinatal outcome in patients with renal transplantation.
Patients and methods: Comparative, observational and retrospective study performed in pregnant patients with renal transplantation, from December 1999 to April 2008 at Perinatology of Hypertensive Diseases Department of the Unidad Médica de Alta Especialidad de Ginecoobstetricia Luis Castelazo Ayala, IMSS. Davison’ guide, descriptive statistic, and Fischer exact test were used.
Results: Thirty patients were analyzed, 27 cases satisfy Davison’s recommended guidelines, and the rest did not achieve these criteria (p = 0.001). Preeclampsia occurred in 15 cases (50%), preterm delivery in 15 (50%), and fetal growth restriction in 6 (20%). Among the 11 patients with previous chronic hypertension, 8 developed superimposed preeclampsia (72%), and 9 had delivery before 37 weeks of gestation (82%). Malfunction of renal transplantation, before pregnancy, was associated with maternal and perinatal poor outcome (p = 0.006). There were no maternal deaths, but one perinatal (3%)
Conclusions: Successful pregnancy is possible in patients with renal transplantation, however there is a high risk of preeclampsia, infection, and fetal growth restriction. Patients with renal transplantation must fulfill Davison’s pre-pregnancy guidelines.

REFERENCES

1. Sibai B, Dekker G, Kupferminc M. Pre-eclampsia. Lancet 2005; 365:785-798.

2. Sibai BM. Diagnosis and management of gestational hypertension and preeclampsia. Obstet Gynecol 2003;102:181-92.

3. Alston PK, Kuller JA, McMahon MJ. Pregnancy in transplant recipients. Obstet Gynecol Survey 2001;56:289-95.

4. EBPG Expert Group on Renal Transplantation. European best practice guidelines for renal transplantation. Section IV: Long-term management of the transplant recipient. IV.10. Pregnancy in renal transplant recipients. Nephrol Dial Trasplant 2002;17:50-55.

5. Maulik D. Management of fetal growth restriction: an evidence based approach. Clin Obstet Gynecol 2006;49:320-34.

6. Lineamiento Técnico. Prevención, diagnóstico y manejo de la preeclampsia/eclampsia. Secretaria de Salud. México, 2007.

7. ACOG Committee on Practice Bulletins-Obstetrics. ACOG practicce bulletin. Diagnosis and management of preeclampsia and eclampsia. ACOG Practice Bulletin No 33, January 2002. Obstet Gynecol 2002; 99:159-67.

8. RCOG (Royal College of Obstetricians and Gynecologist). The management of severe pre-eclampsia/eclampsia. Green-Top Guideline No. 10(A). London RCOG; 2006.

9. Mastrobattista JM, Katz AR. Pregnancy after organ transplant. Obstet Gynecol Clin N Am 2004;31:415-28.

10. Davison JM, Milne JE. Pregnancy and renal transplantation. Br J Urol 1997;80:29-32.

11. Cardonick E, Moritz M, Armenti V. Pregnancy in patients with organ transplantation: a review. Obstet Gynecol Survey 2004;59:214-22.

12. Bar J, Ben-Rafael Z, Pados A, Orvieto R, et al. prediction of pregnancy outcome in subgroups of women with renal disease. Clin Nephrol 2000;53:437-44.

13. Basaran O, Emiroglu R, Secme S, Moray G, Haberal M. Pregnancy and renal transplantation. Transplant Proc 2004;36:122-4.

14. Lessan-Pezeshki M. pregnancy after renal transplantation: points to consider. Nephrology Dialysis Transplantation 2002;17:703-7.

15. Sibai BM. Biomarker for hypertension-preeclampsia: are we close yet? Am J Obstet Gynecol 2007;197:1-2.

16. Leaños A, Marquez J, Cárdenas GM, Chinolla ZL, et al. Urinary prolactin a reliable marker for preeclampsia its severity and the occurrence of adverse pregnancy outcomes. J Clin Endocrinol Metab 2008;93:2492-9.

17. Toledano RM, Izquierdo JC, García Alonso A, Jiménez G, Figueroa S. Morbimortalidad materna y perinatal en pacientes embarazadas con trasplante renal. Ginec Obstet Mex 1999;67:516-21.