Consecutive Spontaneous Triplet and Twin Pregnancies in a Woman After Renal Transplantation

Background: Kidney transplantation is associated with fertility restoration in more than 50% of women with chronic kidney disease. Pregnancy after transplantation may affect women’s health and fetal development, with higher rates of abortion, fetal growth restriction, and neonatal deaths. Twin pregnancy is a condition of high-risk for adverse maternal and perinatal outcomes, and its occurrence in women with previous kidney transplantation is rare. Case: 32-year-old woman, recipient of living donor kidney transplantation, with a history of one pregnancy prior to transplantation, with current normal allograft function and no use of contraceptive method. At ten weeks of amenorrhea, ultrasound investigation showed a dichorionic diamniotic twin pregnancy. The following evaluation showed Chiari type II features in one fetus, and no detectable abnormality in the other one. There was appropriate blood pressure control with no need for an antihypertensive drug, and renal function remained normal without proteinuria. Calcium and a low dose of acetylsalicylic acid were used as preeclampsia prophylaxis. At 33 weeks of gestation, she presented premature rupture of membranes with spontaneous preterm labor. A cesarean section was performed due to the breech presentation of the first fetus. The patient persisted with normal graft function and without graft rejection during follow-up. Discussion and conclusion: Twin pregnancies after kidney transplantation are rare, and it is most frequently associated with preterm birth. We reported a successful twin pregnancy after kidney transplantation, with good perinatal and maternal outcomes, and without graft rejection or dysfunction.

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Twin pregnancy after kidney transplantation: case report and systematic review

Sousa

Guida

Surita

et al. 2021

Braz. J. Nephrol.

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Gravidez gemelar após transplante renal: relato de caso e revisão sistemática

Praça,

Naser,

Silva

et al. 2024

Arch. Health

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Introdução: A gravidez gemelar após o transplante renal é uma condição de risco devido à necessidade de ajustes em regimes imunossupressores, maior probabilidade de complicações obstétricas como pré-eclâmpsia e parto prematuro, e potencial deterioração da função do enxerto renal. Objetivo: Este estudo tem como objetivo avaliar os riscos e os desfechos de uma gravidez gemelar em mulheres que receberam um transplante renal. Metodologia: Para atender a esse objetivo, esta pesquisa adota multi-métodos, incluindo um relato de caso e revisão sistemática. O relato de caso considerou uma paciente de 30 anos, grávida gemelar pós-transplante renal. A revisão sistemática utilizou publicações indexadas nas bases Medline/PubMed, Scielo Brasil e Lilacs, publicadas entre 2019 e 2024. Resultados e discussão:Foram obtidos 12 estudos na revisão sistemática. O relato de caso acompanhou a paciente durante os 9 meses de gestação e o período puerperal. Observou-se que a gravidez gemelar após transplante renal é rara e de alto risco, mas a restauração da fertilidade em mulheres transplantadas pode ultrapassar 50%. Considerações finais: Apesar da restauração da fertilidade, mulheres transplantadas renais ainda possuem riscos significativos de complicações durante a gestação, como aborto, restrição de crescimento fetal e óbitos neonatais.

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Consecutive Spontaneous Triplet and Twin Pregnancies in a Woman After Renal Transplantation

Cited by 2 publications

References 9 publications

Twin pregnancy after kidney transplantation: case report and systematic review

Twin pregnancy after kidney transplantation: case report and systematic review

Gravidez gemelar após transplante renal: relato de caso e revisão sistemática

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