Advanced renal disease/renal impairment

2021 ◽  
pp. 44-55
Author(s):  
Hannah Blakey ◽  
Kate Bramham
Keyword(s):  
Renal Function ◽  
Pregnancy Outcomes ◽  
Impaired Renal Function ◽  
Low Birth Weight Babies ◽  
Term Delivery ◽  
Adverse Pregnancy ◽  
Urine Testing ◽  
First Time ◽  
Baseline Renal Function ◽  
In Pregnancy

There is an increased incidence of chronic kidney disease (CKD) in patients with underlying rheumatic disease. For a proportion of patients, CKD is diagnosed for the first time in pregnancy through routine antenatal blood and urine testing. Pregnancy places increased physiological demand on the kidneys, and women with CKD have increased risks of adverse pregnancy outcomes, including pre-eclampsia (PET), pre-term delivery, and low birth weight babies. These risks increase incrementally with declining baseline renal function. Thorough pre-conception counselling and regular antenatal review by teams specializing in the care of renal and/or rheumatological conditions is recommended to mitigate these risks and optimize outcome for mother and baby. This chapter describes, through case-based discussion, the investigation and management of abnormal renal function presenting in pregnancy, pre-pregnancy counselling for women with CKD, and the principles of antenatal care for women with impaired renal function.

Importance of Oral Health in Pregnancy: A Mini-symposium

2019 ◽  
Vol 15 (3) ◽  
pp. 156-158
Author(s):  
Aditi Priyamvara ◽  
Amit K. Dey ◽  
Antara Bagchi ◽  
Raveena Kelkar ◽  
Rajaram Sharma
Keyword(s):  
Oral Health ◽  
Oral Cavity ◽  
Tooth Enamel ◽  
Relevant Information ◽  
The Body ◽  
Systemic Impact ◽  
Low Birth Weight Babies ◽  
Adverse Pregnancy ◽  
In Pregnancy

Background: It is known that hormonal imbalances during pregnancy make women more susceptible to dental problems. High levels of progesterone and estrogen during pregnancy, lead to an increased inflammatory response to dental plaque thus causing predisposing to gum diseases such as gingivitis. If untreated, gingivitis leads to chronic periodontitis which may manifest systemically in form of cardiovascular, endocrine or even respiratory disorders. Also, hyperacidity in the oral cavity due to gastric reflux and vomiting leads to decreased pH thus damaging the tooth enamel making the oral cavity more prone to tooth decay and tooth loss. Studies also show that periodontal disease can also lead to adverse pregnancy outcomes such as pre-term and low birth weight babies. Objectives: We sought to understand the role of oral health in pregnancy. Methods: We identified major articles of interest in the field of oral health in pregnancy and drafted a mini-symposium based on relevant information. Conclusion: Regular dental visits and cognizant efforts to sustain a healthy oral environment can help women in the prevention and treatment of dental issues during pregnancy. The paper highlights the common oral manifestations during pregnancy and their local and systemic impact on the body during pregnancy. Furthermore, it also emphasizes the importance of good oral health practices to counteract the oral complications and the significance of oral health awareness in pregnant women.

Comparison of pregnancy outcomes after second trimester amniocentesis between procedures performed by experts and non-experts

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Tanapak Wisetmongkolchai ◽  
Fuanglada Tongprasert ◽  
Kasemsri Srisupundit ◽  
Suchaya Luewan ◽  
Kuntharee Traisrisilp ◽  
...  
Keyword(s):  
Pregnancy Outcomes ◽  
Loss Rate ◽  
Fetal Loss ◽  
Adverse Pregnancy Outcomes ◽  
Expert Group ◽  
Second Trimester ◽  
Single Institution ◽  
Adverse Pregnancy ◽  
In Pregnancy ◽  
Singleton Pregnancies

AbstractObjectivesTo compare the rate of fetal loss in pregnancy after second trimester amniocentesis between procedures performed by experts and non-experts and to assess other pregnancy complications as secondary outcomes.MethodsA retrospective cohort study was performed on singleton pregnancies that underwent mid-trimester amniocenteses in a single institution. The fetal loss rates of procedures performed by experts and non-experts were collected and analyzed. Other adverse pregnancy outcomes were also examined.ResultsIn total, 14,450 amniocenteses were performed during the study period. These included 11,357 (78.6%) procedures in the group expert operators and 3,093 (21.4%) procedures in the group non-expert operators. In the non-expert group, the fetal loss rate was slightly increased but not significantly (p=0.24).In addition, the higher number of spontaneous abortions was associated with blood-stained amniotic fluid sample (p<0.001; RR=9.28). Multiple needle insertions also increased in the non-expert group significantly. However, no difference in pregnancy outcomes was found between in single and multiple needle insertions.ConclusionsThe amniocentesis procedures performed by the non-experts was not increase the fetal loss rate. However, the other adverse pregnancy outcomes, including preterm birth, low birth weight and fetal growth restriction were significantly increased in the non-expert group.

scholarly journals Dengue in Pregnancy

2019 ◽  
Vol 34 (1) ◽  
pp. 36-42
Author(s):  
Sameena Chowdhury ◽  
Sharmin Abbasi
Keyword(s):  
Adverse Effects ◽  
Dengue Fever ◽  
Pregnancy Outcomes ◽  
Adverse Outcomes ◽  
Severe Dengue ◽  
Management Guideline ◽  
Serious Infection ◽  
Adverse Pregnancy ◽  
Day By Day ◽  
In Pregnancy

Dengue fever during pregnancy is increasing day by day in Bangladesh. The knowledge of adverse effects on mother and neonate remains limited and there are also lack of management guideline in this regard. Mortality rate for severe dengue fever is 0.8–2.5%, and pregnancy should be considered as a coexisting risk factor for serious infection. However, the maternal and fetal outcomes not fully understood. Some review articles on outcomes of neonates born to mother with dengue fever was reported, and demonstrated that preterm birth and low birth weight were the most common adverse pregnancy outcomes; however, dengue fever was not significantly associated with these adverse outcomes, suggesting that symptomatic dengue fever may indicate risk. Other adverse effects such as stillbirth or postpartum hemorrhage (PPH) remain unclear. Therefore, we aimed to brief review of recent management guideline of OGSB about dengue fever in pregnancy. Bangladesh J Obstet Gynaecol, 2019; Vol. 34(1): 36-42

scholarly journals Schistosomiasis among pregnant women in the Njombe-Penja health district, Littoral region of Cameroon: A cross sectional study

2019 ◽  
Author(s):  
Calvin Tonga ◽  
Charlie Ngo Bayoi ◽  
Flore Chanceline Tchanga ◽  
Jacqueline Félicité Yengue ◽  
Godlove Bunda Wepnje ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Pregnancy Outcomes ◽  
Haemoglobin Concentration ◽  
Epidemiological Data ◽  
Adverse Pregnancy Outcomes ◽  
Health District ◽  
Blood Levels ◽  
Childbearing Age ◽  
Adverse Pregnancy ◽  
In Pregnancy

AbstractBackgroundSchistosomiasis is a Neglected Tropical Disease with endemic foci in Cameroon. Epidemiological data on schistosomiasis in pregnancy are scarce in the country. This study is about schistosomiasis among pregnant women in the Njombe-Penja health district, where schistosomiasis was reported since 1969.MethodologyOverall, 282 pregnant women were enrolled upon informed consent at first antenatal consultation. A questionnaire was administered to document socio-economic and obstetric information. Stool and terminal urine samples were collected and analysed using the Kato-Katz/formol-ether concentration techniques and centrifugation method respectively. Haemoglobin concentration was measured with finger prick blood, using a URIT-12® electronic haemoglobinometer.Principal findingsThe overall prevalence of schistosomiasis was 31.91%. Schistosoma guineensis, S. haematobium and S. mansoni infections were found in 0.35%, 04.96% and 28.01% of participants respectively. Co-infection with 2 species of Schistosoma was found in 04.44% of these women. The prevalence of schistosomiasis was significantly higher in younger women (≤20) and among residents of Njombe. All S. haematobium infected women were anemic and infection was associated with significantly lower haemoglobin levels (p=0.02).ConclusionThe prevalence of schistosomiasis is high in pregnant women of the Njombe-Penja health district, with possible adverse pregnancy outcomes. Female of childbearing age should be considered for mass drug administration.Author summaryPregnant women are known to be more vulnerable to infectious diseases and in their case, at least two lives are at risk. Although schistosomiasis remains a major public health issue in Cameroon, epidemiological data on schistosomiasis in pregnancy are scarce. These data are of high interest for informed decision-making. We examined stools and urines from 282 women of the Njombe-Penja Health district and measured their blood levels. Overall, 31.91% of women were infected, mostly younger ones and those living in the town of Njombe. Three species of Schistosoma parasite were identified. Women having urinary schistosomiasis had lower blood levels. These results show that the prevalence of schistosomiasis is high in pregnant women of Njombe. Also, because of the anemia it induces, the disease can lead to adverse pregnancy outcomes on the woman and her foetus. Treating female of childbearing age would cure the disease and prevent adverse outcomes.

scholarly journals Adverse pregnancy outcomes in women with diabetes-related microvascular disease and risks of disease progression in pregnancy: A systematic review and meta-analysis

PLoS Medicine ◽  
2021 ◽  
Vol 18 (11) ◽  
pp. e1003856
Author(s):  
Sophie Relph ◽  
Trusha Patel ◽  
Louisa Delaney ◽  
Soha Sobhy ◽  
Shakila Thangaratinam
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Preterm Birth ◽  
Pregnant Women ◽  
Pregnancy Outcomes ◽  
Meta Analysis ◽  
Microvascular Disease ◽  
Adverse Pregnancy ◽  
In Pregnancy

Background The rise in the global prevalence of diabetes, particularly among younger people, has led to an increase in the number of pregnant women with preexisting diabetes, many of whom have diabetes-related microvascular complications. We aimed to estimate the magnitude of the risks of adverse pregnancy outcomes or disease progression in this population. Methods and findings We undertook a systematic review and meta-analysis on maternal and perinatal complications in women with type 1 or 2 diabetic microvascular disease and the risk factors for worsening of microvascular disease in pregnancy using a prospective protocol (PROSPERO CRD42017076647). We searched major databases (January 1990 to July 2021) for relevant cohort studies. Study quality was assessed using the Newcastle–Ottawa Scale. We summarized the findings as odds ratios (ORs) with 95% confidence intervals (CIs) using random effects meta-analysis. We included 56 cohort studies involving 12,819 pregnant women with diabetes; 40 from Europe and 9 from North America. Pregnant women with diabetic nephropathy were at greater risk of preeclampsia (OR 10.76, CI 6.43 to 17.99, p < 0.001), early (<34 weeks) (OR 6.90, 95% CI 3.38 to 14.06, p < 0.001) and any preterm birth (OR 4.48, CI 3.40 to 5.92, p < 0.001), and cesarean section (OR 3.04, CI 1.24 to 7.47, p = 0.015); their babies were at increased risk of perinatal death (OR 2.26, CI 1.07 to 4.75, p = 0.032), congenital abnormality (OR 2.71, CI 1.58 to 4.66, p < 0.001), small for gestational age (OR 16.89, CI 7.07 to 40.37, p < 0.001), and admission to neonatal unit (OR 2.59, CI 1.72 to 3.90, p < 0.001) than those without nephropathy. Diabetic retinopathy was associated with any preterm birth (OR 1.67, CI 1.27 to 2.20, p < 0.001) and preeclampsia (OR 2.20, CI 1.57 to 3.10, p < 0.001) but not other complications. The risks of onset or worsening of retinopathy were increased in women who were nulliparous (OR 1.75, 95% CI 1.28 to 2.40, p < 0.001), smokers (OR 2.31, 95% CI 1.25 to 4.27, p = 0.008), with existing proliferative disease (OR 2.12, 95% CI 1.11 to 4.04, p = 0.022), and longer duration of diabetes (weighted mean difference: 4.51 years, 95% CI 2.26 to 6.76, p < 0.001) than those without the risk factors. The main limitations of this analysis are the heterogeneity of definition of retinopathy and nephropathy and the inclusion of women both with type 1 and type 2 diabetes. Conclusions In pregnant women with diabetes, presence of nephropathy and/or retinopathy appear to further increase the risks of maternal complications.

scholarly journals 142: Migraines in pregnancy and select adverse pregnancy outcomes

2020 ◽  
Vol 222 (1) ◽  
pp. S106
Author(s):  
Gretchen Bandoli ◽  
Rebecca J. Baer ◽  
Laura L. Jelliffe-Pawlowski ◽  
Christina Chambers
Keyword(s):  
Pregnancy Outcomes ◽  
Adverse Pregnancy Outcomes ◽  
Adverse Pregnancy ◽  
In Pregnancy

Abstract WP364: Impaired Renal Function and Outcome After Intracerebral Haemorrhage: Data From the Ongoing Tranexamic Acid for Hyperacute Primary Intracerebral Haemorrhage (TICH-2) Trial

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Nikola Sprigg ◽  
Katie Robson ◽  
Zhe K Law ◽  
Jason Appleton ◽  
Philip Bath
Keyword(s):  
Renal Function ◽  
Intracerebral Haemorrhage ◽  
Impaired Renal Function ◽  
Estimated Glomerular Filtration Rate ◽  
Haemorrhagic Stroke ◽  
P Value ◽  
Severe Group ◽  
Baseline Characteristics ◽  
Baseline Renal Function ◽  
Baseline Covariates

Background: Trends between renal failure at presentation and poor outcome in intracerebral haemorrhage (ICH) have been investigated; however, few studies have examined this relationship. Methods: TICH-2 records estimated glomerular filtration rate (eGFR) at baseline. Renal function was categorised as; normal (>60 mL/min), moderate (30-60) and low (<30). Baseline characteristics were compared across all three groups. Moderate and low eGFR was compared to normal for day 90 outcomes and adjusted for baseline covariates. Results: Of 1514 participants in TICH-2 with baseline eGFR recorded, 1277 (84.4%) had a normal eGFR, 214 (14.1%) a moderate eGFR and 23 (1.5%) a low eGFR. Systolic blood pressure was highest in the severe group (normal: 173.4, moderate: 172.0, low: 194.4 mmHg; p-value=0.0078), as was pre-morbid mRS (normal: 0.49, moderate: 0.81, severe: 0.87; p-value=0.0001); however, the moderate group had the highest average age (normal: 68.0, moderate: 75.8, low: 66.9 years; p-value=0.0178) and NIHSS (normal: 12.8, moderate: 14.1, low: 12.4; non-significant) at baseline. Proportionally, the severe group had more previous strokes or TIAs and higher historical rates of heart disease, diabetes and haemorrhagic stroke (see figure); although these differences were not all significant. After accounting for the varied results at baseline; no significant differences were found between the groups when looking at day 90 outcomes, SAEs, deaths, do not attempt resuscitation rates, BP lowering treatment, or length of stay in hospital. Conclusion: Patients with renal impairment had more severe strokes and co-morbidities; however, outcomes did not differ once other prognostic factors were accounted for.

Fertility and Pregnancy in Inflammatory Bowel Disease

2015 ◽  
Author(s):  
Aoibhlinn M. O’Toole ◽  
Sonia Friedman
Keyword(s):  
Pregnancy Outcomes ◽  
Mode Of Delivery ◽  
Reproductive Function ◽  
Pregnant Patient ◽  
Ileoanal Pouch ◽  
Bowel Diseases ◽  
Individualized Approach ◽  
Inflammatory Bowel ◽  
Adverse Pregnancy ◽  
In Pregnancy

Inflammatory bowel diseases (IBDs) commonly affect women in their reproductive years; 25% of women with IBD become pregnant after the diagnosis. The relation of IBD to reproductive function often manifests in issues concerning fertility, antepartum pregnancy management, mode of delivery, and lactation as these can be influenced by disease activity, medications, perianal disease, and previous ileoanal pouch surgery. As disease location, activity, and complications can vary between patients, an individualized approach with multidisciplinary management is recommended. Pregnancy outcomes, recommended medication, nursing, managing IBD flares during pregnancy, and immune pathways are also discussed. Figures show issues discussed in preconception counseling and pregnancy guidelines. Tables list medication recommendations, Food and Drug Administration categories for the use of medications in pregnancy, adverse pregnancy outcomes PIANO registry, pregnancy and biological recommendations, thiopurine recommendations, safety of biologics in pregnancy, biologic guidelines, and sick pregnant patient recommendations. This review contains 2 highly rendered figures, 8 tables, and 29 references. 

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