Book of Medical Disorders in Pregnancy - Tintash

approximately 18% fetal mortality was
noted; 17% of the patients developed
pregnancy induced hypertension. Patients
with nephrotic syndrome present a
reasonably optimistic outcome in the
absence of hypertension or azotaemia.
However, with the advent of either or
both, careful review of the case should
be undertaken to determine the feasibility
of continuation of pregnancy.
Other forms of renal disease to be
considered in pregnancy
Fig6.5: Shows rash of Lupus.
Systemic Lupus Erythematosis (SLE)
- It has been demonstrated that twothirds
of the patients who have SLE have
renal involvement which may be
apparent only on renal biopsy. Ideally,
patients who suffer from SLE and who
anticipate pregnancy should be seen,
evaluated, and counselled prior to
conception. Those cases; of SLE who
have com-promised renal function, particularly
with super added hypertension,
present a very significant risk in
pregnancy both to the fetus and to the
mother. The superimposed pregnancy in-
duced hyper tension, even in the normotensive
patient with Lupus, can be
frighteningly abrupt and lead to a serious
deterioration of the maternal state. The
question of carrying patient’s through
pregnancy with SLE remains controversial.
Even within our own university,
94
two reputable nephrologists take
diametrically opposite views: on the one
sides the view that no woman known to
have systemic Lupus should be allowed
to consider undertaking pregnancy. On
the other side, in the light of a relatively
large experience, the fact that although
renal impairment has been identified and
moderate hypertension is present, with
extremely careful prenatal care, in active
pregnancy outcome may be achieved. It
is my personal view that in the case
where renal impairment has been
demonstrated, particularly if hypertension
is present, pregnancy should be
discouraged. In the situation where pregnancy
is desired and the patient is
aware of the risks, control of hypertension
by appropriate agents is desirable.
Hypotensive agents that will improve
renal blood flow should be
chosen. Careful monitoring of the patient's
state by an obstetrician and nephrologist
is mandatory for the evaluation of
the integrity and growth of the fetuplacental
unit. The sudden advent of
pregnancy induced hypertension in the
vast majority of cases will warrant
immediate termination of the pregnancy.
In patients with SLE, delivery does not
end the chapter. Determination of the
Lupus may lead to a progressive
downhill course, acute renal failure or
the onset of a nephrotic syndrome in the
mother.
Fig6.6: Shows section of polycystic
kidney.