Chronic renal disease and pregnancy outcome

Article Abstract:

The effects of pregnancy on the progression of chronic renal (kidney) disease are not known. One study showed that among 23 pregnant women with moderate impairment of kidney function, one-third had worsening of kidney function. Ninety-two percent of these women had live births, 60 percent had premature births, and 10 percent of pregnancies ended in death of the newborn. Other complications of pregnancy associated with impaired kidney function include hypertension (high blood pressure) and preeclampsia, a condition characterized by increasing hypertension, headaches, excretion of protein in the urine, and fluid retention in the lower limbs. In this study, pregnancy outcome was assessed in 37 women with moderate or severe impairment of kidney function. The women were studied over an 18-year period between 1971 and 1988. They had complications of pregnancy including anemia, chronic hypertension, and preeclampsia. Birth-related complications included miscarriages in the middle of pregnancy, low birth weight due to premature birth, and slowed growth of the fetus. Among the 26 women with moderate impairment of kidney function, 85 percent of the pregnancies resulted in live births, and there was only one stillbirth with no newborn deaths. Among the 11 women with severe kidney impairment, seven had live infants which were delivered at 26 weeks' gestation or later. Kidney function worsened in only six of 37 women. Kidney failure developed at an average of four years after delivery in eight of 37 women. The normal increase in blood volume occurring during pregnancy was reduced in women with severe kidney disease. (Consumer Summary produced by Reliance Medical Information, Inc.)

Development and progression, Prognosis, Kidney diseases, Chronic kidney failure

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On reducing the frequency of severe abruptio placentae

Article Abstract:

Abruptio placentae is the premature detachment of a normally situated placenta. In severe cases, it can cause death of the fetus and sometimes even the mother. At one particular hospital, the rate of severe abruptio placentae decreased from 1 in 420 deliveries during the period 1956 through 1969 to 1 in 830 deliveries during the period 1974 through 1989. This study examined the factors associated with the decline in the rate of severe abruptio placentae. Patient records were reviewed to examine which factors that might be associated with abruptio placentae could be manipulated to further reduce the rate. Factors associated with the decline in the rate of abruptio placentae included a decline in high parity rates, that is, having given birth to many children, and a change in the racial composition of the hospital's patients. The number of Latin American women who delivered at the hospital had increased relative to the number of white and black women who delivered at the hospital. The rate of abruptio placentae is lowest among Latin American women and highest among black women. The reason for these racial differences is unknown. In both time periods, women who suffered from hypertension or who had previously suffered from abruptio placentae had a higher risk. Results indicated that even with reduced rates, severe abruptio placentae remained a prominent cause of fetal death. (Consumer Summary produced by Reliance Medical Information, Inc.)

Abnormalities, Risk factors, Demographic aspects, Placenta, Abruptio placentae, Placental abruption

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Pregnancy complicated by hemoglobin CC and C-beta-thalassemia disease

Article Abstract:

Several kinds of hemoglobinopathy (diseases that result in abnormal hemoglobin, the molecule that carries oxygen in the blood) have been identified, and some types are associated with complications of pregnancy. The incidence of either hemoglobin C or C-beta-thalassemia (two types of hemoglobinopathy) in American blacks is approximately 2 percent. Twenty black women were studied; they had either hemoglobin CC or C-beta-thalassemia. The 15 women with hemoglobin CC had a total of 49 pregnancies, and had mild to moderate anemia (insufficient number or function of red blood cells) during pregnancy. The remaining five women, with C-beta-thalassemia, accounted for 23 pregnancies. Little illness was associated with the hemoglobinopathy in both groups of women. The spontaneous abortion rate of 11 percent did not differ from that of the general population, and none of the women needed a blood transfusion. These conditions do not appear to present significant problems for pregnant women. Iron and folic acid supplementation during pregnancy is advised to minimize the anemia. In contrast, another hemoglobinopathy that occurs in blacks, sickle cell disease, does cause complications of pregnancy. (Consumer Summary produced by Reliance Medical Information, Inc.)

Pregnancy, Thalassemia, Hematologic diseases, Hemoglobinopathy, Hemoglobinopathies, Blood diseases in pregnancy

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