1. TEMPLATE DESIGN © 2008 www.PosterPresentations.com Maternal and fetal outcomes in women with chronic kidney disease M Kalidindi, S Marlene, K Bennett-Richards, R Khan Royal London Hospital, Barts Health NHS Trust, London Background Pregnant women with chronic kidney disease are less able to adapt to the physiological haemodynamic, renal tubular and endocrine changes that take place in pregnancy and this may lead to the accelerated decline in renal function and poor pregnancy outcome. Chronic Kidney disease is classified into five stages based on the level of renal function 1. Renal impairment with normal or raised glomerular filtration rate (GFR) of ≥ 90 is called stage 1 and mildly low GFR of 60 - 89 is stage 2. Stage 3 is moderately low GFR of 30 – 59, stage 4 is severely low GFR of 15 – 29 and stage 5 is kidney failure with GFR <15 or dialysis. Mild renal impairment (stages 1-2) affect up to 3% of women of child bearing age and pregnancy in these women is usually uneventful with good renal outcome 2. Women with pre pregnancy moderate – severe renal impairment (stages 3 – 5 or serum creatinine values >124 μmol/l) are at greatest risk of complications during pregnancy and of accelerated decline in renal function 3. Pre-existing hypertension and proteinuria increase this risk and the degree of renal dysfunction correlates with the risk of poor pregnancy outcome. Optimal management of pregnant women with chronic kidney disease requires expert management in the specialist multidisciplinary clinics with timely interventions in order to achieve successful pregnancy outcome with conservation of renal function. Methods Retrospective review of all the electronic records of the pregnant women with Chronic Kidney Disease and pregnant women post renal transplant, who had antenatal care in the specialist multidisciplinary Obstetric Renal clinic in a tertiary inner city London hospital over a period of 18 months from May 2010 to December 2011. Results Conclusions References Our maternal and fetal complication rates in women with renal disease are comparable with the recently published evidence. Women with chronic kidney disease who become pregnant with mild renal dysfunction (stages 1 – 2) usually have an uneventful pregnancy and good renal outcome. Women with moderate to severe disease (stages 3 – 5) are at highest risk of complications during pregnancy with accelerated decline in renal function. Optimising the renal condition by educating women and through pre-pregnancy counselling along with frequent monitoring of clinical and biochemical parameters with timely interventions will improve the maternal and fetal outcomes. Considerable advances in the antenatal care with high quality maternal services is pivotal for successful impact on the maternal and fetal outcome. OPTIONAL LOGO HERE 1.Williams D, Davison J. Chronic kidney disease in pregnancy. BMJ 2008:336:211-5 2.Jungers P, Houillier P, Forget D, Labrunie M, Skhiri H, Giatras I, et al. 3. Renal disease in Pregnancy. Consensus views arising from 54 th study group. RCOG press http://www.rcog.org.uk/files/rcog-corp/uploaded- files/StudyGroupConsensuViewsRenalDisease.pdfhttp://www.rcog.org.uk/files/rcog-corp/uploaded- files/StudyGroupConsensuViewsRenalDisease.pdf 4. Renal disease in pregnancy. J M Davison, C Nelson - Piercy, S Kehoe, P Baker. ISBN: 978-1-904752-59-2. RCOG Press. 2008 Objectives Evaluation of maternal and fetal outcomes in pregnant women with chronic kidney disease (CKD) or post renal transplant, who were referred to and cared for during pregnancy in the specialist Obstetric Renal clinic catering a very high risk multiethnic population of east London. Results In total, twenty seven women received antenatal care in our specialist multidisciplinary Obstetric renal clinic over a period of eighteen months, including two post renal transplant women. Forty percent of women were of Asian/Bengali origin, 30% were white, 15% Black and rest are of other /mixed ethnicity. More than 70% of the women were of parity one or more and of BMI less than 30. Of these twenty seven, seven women had moderate to severe renal impairment (CKD stage 3- 5) and the rest had mild renal impairment. With a wide range of the primary renal pathology. Eleven women (40%) had chronic hypertension and thirteen women (48%) had significant proteinuria at booking. Thirteen women were on one or more disease modifying drugs for renal disease and one woman was on dialysis during the pregnancy. All the women with renal disease in pregnancy were cared for in the specialist multidisciplinary Obstetric Renal clinic with monthly renal function tests and four to six weekly mid stream urine checks for infection and proteinuria where appropriate. Eleven out of twenty one women had spontaneous onset of labour, seven were induced and three women had elective caesarean section. Of the women that went into labour either spontaneously or after induction of labour, 56% had normal vaginal delivery, 28% had instrumental delivery and 16% had emergency caesarean section due to failure to progress or presumed fetal compromise. Less than 10% of women had preterm delivery and less than 5% of women had postpartum haemorrhage. Appropriate High dependency care was provided to all women during intrapartum and postpartum period and contraceptive advise was documented in 63%. In women with mild renal impairment (CKD stage 1- 2), pregnancy had minimal impact on the renal prognosis with no significant deterioration in the renal function and similarly, there were no adverse maternal or fetal outcomes. Although two babies were admitted to the neonatal unit due to severe fetal growth restriction, there were no complications of stillbirth, preterm delivery or preeclampsia. All the women with significant proteinuria are assessed for thromboprophylaxis and 23% of women were placed on low molecular weight heparin during the antenatal period. More than 75% of these women were on low dose Aspirin during the pregnancy. 33% of women were anaemic and 51% were found to have vitamin D deficiency at the time of booking and all these women were placed on oral iron and calcium supplementation. 75% of women had uterine artery Doppler screening at the time of anomaly scan and more than 90% of the results were screen negative. Only two of the women with moderate to severe CKD developed preeclampsia. 78% of women had serial growth scans during pregnancy and four cases of fetal growth restriction cases were documented. In those with moderate to severe renal impairment (CKD stage 3-5), forty percent had significant deterioration in the renal function, and sixty percent developed preeclampsia. There was also significant increase in the admission to neonatal unit secondary to fetal growth restriction (2/5).