Perinatal outcome in renal allograft recipients: prognostic significance of hypertension and renal function before and during pregnancy

Article Abstract:

One of every 20 women of childbearing age who receives a kidney transplant (allograft) now becomes pregnant; this figure that has increased dramatically in the last 15 years. Although many women have successful outcomes, half of these pregnancies are complicated and evidence exists that consideration of certain physiological aspects before pregnancy can help predict the outcome. To learn more about the effects of kidney function on pregnancy outcome in renal allograft recipients, 22 pregnancies that progressed past the second trimester were assessed. The 17 women involved in the study were evaluated before and during pregnancy, with fetal evaluation conducted at two-week intervals after the 28th week. Adverse outcomes (stillbirth, growth retardation, and neonatal death) occurred in 10 pregnancies. Plasma creatinine (a substance that reflects kidney function) and creatinine clearance were not different in women with poor and satisfactory outcomes. In no case did renal function deteriorate markedly during pregnancy. However, women with adverse outcomes had higher mean arterial blood pressures at 16, 20, 24, and 28 weeks' gestation than those with satisfactory outcomes. In the group with adverse outcomes, the arterial pressure increased steadily until delivery, while in the group with satisfactory outcomes, it remained at a constant level from 20 weeks' gestation until shortly before delivery. Hypertension (high blood pressure) before 28 weeks was always associated with a poor outcome; after 28 weeks, it was associated with poor outcomes in only two of nine cases. Even though all these patients met standard criteria for allowing pregnancy, adverse outcomes were common. These outcomes were not related to poor renal function, which, on the whole, was only mildly impaired. It is possible that more aggressive treatment of hypertension during pregnancy in renal allograft recipients is indicated. (Consumer Summary produced by Reliance Medical Information, Inc.)

Hypertension, Prognosis, Kidneys, Kidney transplantation, Transplantation of organs, tissues, etc., Organ transplantation, Tissue transplantation, Transplantation

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Management of pregnancy after major urinary reconstruction

Article Abstract:

Many women of reproductive age have had reconstructive surgery of urinary structures. These reconstructions include urinary diversions, bladder augmentation or bladder replacement. In some patients, pregnancy may compromise bladder or kidney functioning or endanger the fetus. A total of 16 women having 18 pregnancies after urinary reconstruction were reviewed. There were 15 deliveries of healthy infants, eight of which were delivered by cesarean section. Urinary retention was experienced by two women, three women became incontinent (which resolved after delivery) and four women developed a urinary tract infection. To prevent urinary tract infections, antibiotic coverage during pregnancy is suggested. Since a vaginal delivery can disrupt the urinary reconstruction, cesarean section delivery is recommended, particularly in women having bladder neck or urethral reconstruction or placement of an artificial urinary sphincter. Pregnancy after urinary reconstruction has a low complication rate. Physicians are urged to continue reporting obstetrical experience in women with bladder reconstruction. (Consumer Summary produced by Reliance Medical Information, Inc.)

Surgery, Urologic surgery, Urinary organs

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Eosinophilic fasciitis during pregnancy

Article Abstract:

Cases of eosinophilic fasciitis, a rare disease causing pain, swelling and tenderness of the arms, hands and feet, followed by hardening of the skin (induration), had never been documented during pregnancy, until this case. The disease was diagnosed by studying a tissue sample (biopsy) of the deep fascia, the fibrous tissue lying deep in the skin, of the affected area. Treatment with the steroid prednisone is recommended. Conditions associated with the disease, such as carpal tunnel syndrome, caused by the compression of the nerves in the wrist, are discussed.

Health aspects, Abnormalities, Prednisone, Eosinophilia, Carpal tunnel syndrome, Fasciae (Anatomy), Eosinophil disorders, Fascia

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