Rajeshwari S. N1 , Asha Swarup 2 , Mahesh E 3
ABSTRACT: Renal failure in obstetrics is rare but important complication, associated with significant mortality and long term morbidity.1,2 It includes acute renal failure due to obstetrical complications or due to deterioration of existing renal disease. AIMS AND OBJECTIVES: To evaluate the etiology and outcome of renal failure in obstetric patients. METHODS: We prospectively analyzed 30 pregnant and puerperal women with acute renal failure or pre-existing renal disease developing renal failure during pregnancy between November 2007 to sep-2009. Patients who presented/developed ARF during the hospital stay were included in this study. RESULTS: Among 30 patients, mean age was 23 years and 33 years age group. 12 cases (40%) patients were primigravidae and 9(30%) patients were multigravidae and 9 cases (30%) presented in post-partum period. Eighteen cases (60%) with ARF were seen in third trimester, followed by in postpartum period 9 cases (30%). Most common contributing factors to ARF were Pre-eclampsia, eclampsia and HELLP syndrome 60%, sepsis 56.6%, post abortal ARF 10%. DIC 40%. Haemorrhage as the aetiology for ARF was present 46%, APH in 20% and PPH in 26.6%. The type of ARF was renal in (63%) and prerenal (36%); Oliguric seen in 10 patients (33%) and high mortality (30%). Among the 20 pregnant patients with ARF, The average period of gestation was 33±2 weeks (30 -36 weeks), 5 cases (25%) presented with intrauterine fetal demise and 18 cases (66%) had preterm vaginal delivery and 2 cases (10%) had induced abortion. And the average birth weight was 2±0.5 kg (1.5 kg). Eight cases (26%) required dialysis. 80% of patients recovered completely of renal functions. 63% patients recovered without renal replacement therapy whereas 17% required dialysis. the maternal mortality was 20%, the main reason for mortality was septic shock and multi organ dysfunction (66%). CONCLUSION: ARF related pregnancy was seen commonly in the primigravidae and in the third trimester, the most common reasons were pregnancy induced hypertension, HELLP syndrome and obstetric haemorrhage and resulted in high risk condition for fetal and maternal mortality. The most effective measures still remain the careful prevention and the aggressive management of the obstetric complications. Ideal care for women with acute renal failure in pregnancy or post-partum requires a multidisciplinary approach that includes maternal-fetal medicine, critical care medicine, nephrology and neonatology specialties.
