Obstetric Management Issues

Pregnancies in female recipients of all organ types must be monitored as high-risk cases and teamwork is essential.53 Management requires attention to serial assessment of transplant function, hematology, blood pressure control, diagnosis and treatment of rejection, treatment of any infections and serial fetal surveillance. It is essential to carefully assess the woman's emotional attitude and the overall support she receives from her family.

Preterm delivery (before 37 weeks gestation) is common because of intervention for obstetric reasons and the tendency to premature labor. Unless there are specific problems, however, spontaneous onset of labor can be awaited. Vaginal delivery is the aim and cesarean section is only necessary for obstetric reasons. Vaginal delivery does not cause mechanical injury to a renal transplant, and neither does the graft obstruct the birth canal.

Augmentation of steroids is necessary to cover delivery and aseptic technique is advisable at all times. Any surgical procedures, however trivial, should be covered by prophylactic antibiotics. Fetal monitoring is advisable. Pain relief is conducted as for healthy women.

Whatever the organ transplant, after surgery, endocrine and sexual functions return rapidly. If according to a suitable set of guidelines, prepregnancy assessment is satisfactory, pregnancy can be advised. In most, a wait of 18 months to 2 years post-transplant has been recommended. By then, the recipient will have recovered from surgery, graft function will have stabilized and immunosuppression will be at maintenance levels. Couples who want a child should be encouraged to discuss all the implications, including the harsh realities of maternal survival prospects.

Acknowledgments

The authors are indebted to transplant coordinators, physicians, and recipients nationwide who have provided their time and information to the registry. The NTPR is supported by grants from Novartis Pharmaceuticals Corporation, Fujisawa Healthcare, Inc., and Roche Laboratories Inc. The authors acknowledge Ann Nickolas for her assistance with the preparation of the manuscript.

This article is reprinted from Graft 2000; Vol. 3, No. 2:59-63, with permission from the authors.

References

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