There is a paucity of data on pregnancy outcome in women living with a single kidney from all causes. Current thinking is extrapolated from living kidney donors, a group biased by strict selection criteria. We present a cohort of 26 women with a solitary functioning kidney; 11 women had an acquired single kidney of whom only 1 was a living donor and 15 had a congenital single kidney. Median time living with a single kidney was 28 years. None booked with hypertension or proteinuria. Urinary tract infection complicated 50% of pregnancies. Worryingly, 35% developed pre-eclampsia, gestational proteinuria or gestational hypertension. We propose pre-conceptual counselling, education on how to protect their single kidney, pre eclampsia prophylaxis with low-dose aspirin and close monitoring for urinary tract infection, hypertension and proteinuria with lower thresholds for pharmaceutical management. We have devised a Patient Information leaflet – ‘Living with a single kidney, pregnancy and beyond’.
Background and aims: Gestational diabetes is defined as 'carbohydrate intolerance first recognised in pregnancy'. The definition encompasses women diagnosed in early pregnancy. Concerns exist that such cases phenotypically resemble those with established pre-existing diabetes and therefore have a higher risk profile. We aim to evaluate women diagnosed with impaired carbohydrate intolerance in early pregnancy and compare them with those with established Type 2 diabetes and gestational diabetes diagnosed on routine screening (24À28 weeks' gestation). Methods: We retrospectively reviewed 84 women who attended our inner-city conjoint antenatal clinic (2009À2012). Baseline demographics, insulin therapy requirement and outcomes were compared in women with gestational diabetes diagnosed prior to routine screening (group 1, n = 18) and women with established Type 2 diabetes (group 2, n = 66). A separate cohort of age-matched controls with routinely diagnosed gestational diabetes was identified (group 3, n = 18). Results: Mean age (groups 1À3, 35.6 years, 32.6 years, 35.4 years respectively) and proportion of women originating from non-Caucasian ethnicities (72%, 74%, 78%) were similar across the groups. Women were significantly more likely to be multiparous in group 1 (85%, 15%, 13.6%). Mean booking body mass index (BMI) in groups 1 and 2 were similar: group 1 had a significantly higher booking BMI than group 3 (32.3kg/m 2 ; 30.4kg/m 2 ; 28.3kg/ m 2 ). Differences in HbA1c at booking/diagnosis displayed similar patterns [group 1, 61.4mmol/mol; group 2, 58.5mmol/mol (p = ns); group 3, 38.3mmol/mol (p < 0.005)], as did requirement for insulin therapy [group 1, 94%; group 2, 83.3% (p = ns); group 3, 27.8% (p = 0.04)]. Unplanned Caesarean section rates (33.3%, 28.8%, 38.9%), mean fetal birth weight (3,402g AE 767; 3,257g AE 690; 3,218g AE 503) and birth weight centile (60 AE 37; 59 AE 36; 45 AE 25) were similar across the groups. A higher proportion of infants were born large for gestational age in group 1 and group 2 (27.8%, 25.8%, 5.6%; p = ns). Conclusions: Our analysis has demonstrated that women with carbohydrate intolerance diagnosed early in pregnancy phenotypically resemble those with Type 2 diabetes both in terms of treatment required and outcomes. The role of HbA1c at booking could be investigated as a potential screening tool. A34 (P394)Fasting plasma glucose (FPG) alone will miss persisting postnatal glucose abnormalities in gestational diabetes Aims: To assess the utility of FPG in detecting persisting postnatal hyperglycaemia in gestational diabetes.Methods: Retrospective data were collected for all antenatal and postnatal oral glucose tolerance tests (OGTT) between January 2008 and 2013 across three centres in the West Midlands that used selective screening and WHO criteria. A descriptive study was undertaken comparing the utility of OGTT and FPG postnatally. Results: In all, 14,360 women were screened antenatally; 1,289 women had gestational diabetes and 632 (49%) had OGTT (mean AE SD: 9.4 AE 4.1 weeks). Mean...
Complete congenital absence of the omentum is very rare with only one previously reported case. We present a unique case of the management of a pregnant woman with a large pelvic pseudocyst caused by complications related to congenital absence of omentum, resulting in acute kidney injury, likely secondary to acute compartment syndrome. This case highlights the importance of considering acute compartment syndrome in critically unwell pregnant women and reiterates the need to measure intra-abdominal pressure when clinically indicated. Given that pregnancy is in itself a state of intra-abdominal hypertension, obstetricians should maintain a high index of suspicion in the context of additional risk factors.
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