Postoperative renal function in parturients with severe preeclampsia who underwent cesarean delivery: a retrospective observational study

Mazda, Yusuke; Tanaka, Motoshi; Terui, Keita; Nagashima, Sayuri; Inoue, Rie

doi:10.1007/s00540-018-2492-x

Cited by 4 publications

(5 citation statements)

References 18 publications

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“…Studies have shown that a prior surgical cesarean section leads to an increase to the progression of preeclampsia in a subsequent pregnancy. The extended interval between pregnancies among patients who previously experienced cesarean section is a major risk factor for preeclampsia [ 30 , 31 ], suggesting that the advantage of a high parity regarding the risk of preeclampsia is only transient. This evidence supports the considerably high and increasing cesarean section rate in West Bengal in India [ 32 , 33 ].…”

Section: Discussionmentioning

confidence: 99%

Socioeconomic and epidemiological milieu of maternal death due to eclampsia in West Bengal, India: A mixed methods study

2022

Health Care Science

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Background: West Bengal is experiencing an unanticipated risk of eclampsia among pregnant women and it persists as the leading cause of maternal mortality. This study aimed to investigate the predictors for maternal deaths due to eclampsia in West Bengal. Methods:The study adopted retrospective mixed methods covering facility and community-based maternal death review approaches. Facility-based data were used for 317 deceased cases wherein the community-based review approach was used in 40 cases. An in-depth interview was also performed among 12 caregivers.Results: One-third of maternal deaths occurred due to eclampsia, and this accounted for the leading cause of maternal deaths in West Bengal. A younger age, a primigravida or nulliparous status, absence of antenatal care (ANC), and residence in rural areas appeared to have the highest risk of developing eclampsia.The majority of pregnant women had an irregular antenatal check-up history, particularly during the second trimester of pregnancy. The rate of eclampsia-related maternal death was higher in women residing more than 49 km from the studied hospitals. Most of the deceased women were referred to three or more hospitals before their death. Gravidity, the number of ANC visits, the mode of delivery, and delays at different levels were significant confounders of death due to eclampsia.The risk of death due to eclampsia was two times higher among women without ANC and those who had a cesarean section than that in their counterparts.Conclusions: Women in West Bengal have a high risk of preeclampsia and eclampsia resulting in maternal mortality and morbidity. Gravidity, the number of ANC visits, the mode of delivery, and delays in recognition of eclampsia contribute to the risk of maternal deaths. The establishment of

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Section: Discussionmentioning

confidence: 99%

Socioeconomic and epidemiological milieu of maternal death due to eclampsia in West Bengal, India: A mixed methods study

2022

Health Care Science

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“…In the study by Huang C et al [ 47 ], the incidence of AKI in patients with SP who underwent caesarean section was as high as 60%. The clinical situation of the patient, the heterogeneity for AKI definition used by the authors and the intraoperative management of blood volume can decisively influence the incidence of AKI associated with caesarean section [ 49 , 50 , 51 ]. In our series, we relate caesarean section to the association between AKI in the SP patients however, since we did not record the time at which AKI appears in patients, before or after cesarean section, we cannot attribute a causal association of it to the development of AKI.…”

Section: Discussionmentioning

confidence: 99%

“…The prognosis of AKI associated with preeclampsia is relatively good as long as there are no other associated complications, such as sepsis, DIC or severe bleeding, and most patients resume normal renal function postpartum [ 29 , 50 ]. Persistent renal dysfunction and the need for dialysis is more common in patients with previous CKD [ 20 , 57 ].…”

Section: Discussionmentioning

confidence: 99%

Maternal-Perinatal Variables in Patients with Severe Preeclampsia Who Develop Acute Kidney Injury

Rodríguez-Benítez

Moreno

Barrecheguren

et al. 2021

JCM

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Introduction: At present, we are witnessing an increase in preeclampsia, especially the most severe forms, which are associated with an increased risk of maternal-perinatal morbidity and mortality. As a severity criterion, acute kidney injury (AKI) has been associated with a worse prognosis, and for this reason, the maternal and perinatal variables associated with AKI in patients with severe preeclampsia (SP) were analysed in this study. Methods: An observational, retrospective, single-centre study of patients with SP treated at a tertiary hospital between January 2007 and December 2018 was conducted. The case criteria based on the criteria established by the ACOG Practice Guidelines for Gestational Hypertension and Preeclampsia. AKI is considered when serum creatinine exceeds 1.1 mg/dL in a pregnant woman with previously normal renal function. In patients with existing chronic kidney disease (CKD), it is referred to as AKI if the baseline serum creatinine increases by 1.5 fold. Pregestational, gestational and postpartum variables were analysed up to 12 weeks postpartum using univariate and multivariate logistic regression analysis. Results: During the study period, 76,828 births were attended, and 303 pregnant women were diagnosed with SP. The annual incidence of SP increased gradually throughout the study period, reaching 1.79/100 births/year in 2018. Acute kidney injury (AKI) occurred in 24.8% of the patients. The multivariate analysis revealed an increased association with a history of previous CKD, the use of assisted reproductive techniques and caesarean section. Uric acid and thrombotic microangiopathy (TMA) had a high correlation with AKI. Indications for caesarean section are associated with AKI in SP. Regarding perinatal outcomes in cases of AKI, there was a higher percentage of neonates who required foetal lung maturation with steroids and an increased need for NICU admission. No case of maternal death was recorded; however, an increase in neonatal mortality was found among patients who did not develop AKI. After 12 weeks postpartum, 72 patients were referred to the nephrology consultation for persistent hypertension, proteinuria or renal failure. Conclusions: In preeclampsia, AKI is a common complication, especially among patients with a history of CKD, those who became pregnant using assisted reproduction techniques and those who delivered via caesarean section. The perinatal impact of AKI is mainly centred on a higher rate of NICU admission and a lower mortality rate. Among biochemical and haematological markers, the uric acid level prior to renal failure has a direct and significant correlation with the risk of AKI, as does the development of TMA in patients with preeclampsia. Therefore, the monitoring of renal function in cases of preeclampsia should be strict, and referral for a nephrology consultation may be necessary in some cases.

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“…We read with interest the study by Mazda et al [1] regarding postoperative acute kidney injury (AKI) in parturients with severe preeclamsia. We would like to discuss the clinical implication of the study.…”

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confidence: 99%

Acute kidney injury in parturients with severe preeclampsia

Park

Hur

2018

J Anesth

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Postoperative renal function in parturients with severe preeclampsia who underwent cesarean delivery: a retrospective observational study

Cited by 4 publications

References 18 publications

Socioeconomic and epidemiological milieu of maternal death due to eclampsia in West Bengal, India: A mixed methods study

Socioeconomic and epidemiological milieu of maternal death due to eclampsia in West Bengal, India: A mixed methods study

Maternal-Perinatal Variables in Patients with Severe Preeclampsia Who Develop Acute Kidney Injury

Acute kidney injury in parturients with severe preeclampsia

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