Book of Medical Disorders in Pregnancy - Tintash

een preferred because of the site of the
transplant on the pelvic side-wall, which
provides relative cephalopelvic
disproportion and possibly incr-eased
trauma to the transplanted kidney as the
fetus proceeds through the pelvis.
Experienced obstetricians will know
how many times they have encountered
the patient with renal disease, identified
for the first time during pregnancy. From
the foregoing text, students will suspect
It is extremely important that all patients
who manifest evidence of renal disease
for the first time during pregnancy
should be carefully followed after the
pregnancy, details of their renal disease
worked out, and appropriate counseling
offered for future pregnancies.
That many of the signs and symptoms of
renal disease will present for the first
time during pregnancy, and that because
of the pregnancy state appropriate investigation
and delineation of the true
aetiology of the problem is impossible.
Management options:
Systemic lupus erythematosus:
Pre-pregnancy:
Establish good control of SLE: adjust
maintenance medications, If possible,
discontinue azathioprine, methotrexate
this should be done only under careful
supervision. Laboratory assessment for
anemia, Thrombocytopenia, underlying
renal disease and antiphospholipid
antibodies (? +anti RO/SSA and anti-
La/SSB) Counsel patient regarding
potential for SLE exacerbations,
pregnancy induced hypertension risk,
and fetal/neonatal risks
98
Prenatal: Joint obstetrician and
physician surveillance, Encourage early
prenatal care. Accurate dating with
ultrasono-graphy in early pregnancy.
Close follow-up every 2 weeks in first
and second trimesters: every week in
third trimester. Watch for signs or
symptoms of SLE flare, superimposed
pregnancy-induced hypertension, fetal
growth restriction for SLE patients with
renal involvement, perform. Monthly
24h urine collections for creatine
clearance and total protein Drugs:
glucocorticosteroids are safe:
azathioprine as second line therapy if
steroids ineffective (IUGR risk):
methotrexate and cyclophosphamide as
third-line therapy after the first trimester:
avoid antimalarials and full dose
NSAIDs. Serial ultrasonography
examinations for fetal growth, umbilical
artery Doppler recordings and amniotic
fluid volume. Being prenatal testing at
30-32 weeks gestation (earlier in patients
with worsening disease, evidence of fetal
compromise, or with a history of poor
pregnancy outcome). Consider low-dose
aspirin therapy.
Labor/delivery: Deliver at term in
absence of complications: avoid
postdates. Continuous electronic fetal
monitoring. Steroid boluses at delivery
for patients on chronic steroid therapy
Pediatric and anesthesiology notification
Postnatal:
Watch for SLE exacerbation. Restart
maintenance therapy. Evaluate neonate
for SLE-associated manifestations.
REFERENCES:
1. Dixon, H.G. and Brant, H.A. (1967):
Lacet 1.19.