신장이식술을 받은 여성의 산과적 예후 = Obstetric Outcome after Renal Transplantation

다국어 초록 (Multilingual Abstract)

Objective : To evaluate the outcome of pregnancy in kidney transplanted women, and correlate this with the time of transplantation to conception. Material and Methods : We analyzed the outcome of 31 pregnancies from 21 allograft recipients at Kangnam St. Mary`s Hospital, Catholic Medical Center from January 1990 through December 2000. For each reported pregnancy we reviewed obstetrical, medical and pediatric records. For children follow-up and for those whose obstetric procedures were taken in other hospitals, we did a questionarie and telephone interviews. Results : Of the 31 pregnancies followed by us, there were 23 live-born offspring delivered by 21 mothers and 8 stillborn/abortuses, including five artificial abortuses. The mean gestational age at delivery was 36.18±0.6 weeks and the mean birth weight of the offspring was 2,525±137gm. Only 43.4% was delivered after 37weeks of gestation. Preterm delivery rate (delivered before 37weeks of gestation) was 56.5%. Common obstetric complications were intrauterine growth restriction (39.1%) preterm labor (35%), premature rupture of membrane (30%), preeclampsia (30%), and maternal complications were deterioration of renal function (5%) and rejection of allograft (18%) after delivery. Mean interval from transplantation to pregnancy was 4.7 years. Twelve pregnancies occurred within the first 2 years of transplantation, while 19 pregnancies occurred after that period. No difference was noted in neonatal body weight between 2 groups (p=0.824). There was no difference in mean interval from transplantation to pregnancy in the delivery group (5.21±0.9 years) vs. the abortion group (4.57±1.1 years) (p=0.207). All women continued with her medication during pregnancy, based on cyclosporine and/or azathioprine and steroids. No congenital anomaly was noted in the newborn. When follow up lately, one boy with neurofibromatosis and a girl with recurrent hematuria were noted. Conclusion : Although pregnancy in renal allograft patient is hazardous, good outcome can be expected if function of the allograft is good before conception.