Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content +++ OBSTETRIC AND GYNECOLOGIC CARE AFTER TRANSPLANTATION +++ Pregnancy ++ Approximately 40% of female transplant recipients are of childbearing age (18–49 years) Until recently, delaying pregnancy for up to 24 months after transplantation was recommended Currently pregnancy may be considered after 1 year from transplantation if the following criteria are met: No graft rejection in past year Stable graft function For renal transplants, require serum creatinine <1.5 mg/dL with minimal proteinuria Low risk of infections such as cytomegalovirus (CMV), toxoplasmosis Not currently taking teratogenic medications Immunosuppressant dosing at stable maintenance levels with the ability to be monitored during pregnancy. It is important to individualize timing for each patient The better optimized graft function, the greater the likelihood of successful maternal and fetal outcomes All pregnancies posttransplant are considered high-risk Need close surveillance by transplant physicians and high-risk perinatologists Live birth rate of 72.9% in renal transplant recipients Goals of pregnancy Maintain maternal health and graft function with stable immunosuppressant dosing Minimize pregnancy complications such as preterm delivery, hypertensive disorders, and fetal growth restriction Cesarean deliveries only for obstetric indications Pelvic kidney transplants not indication for cesarean delivery Even with thoracic transplant recipients, cesarean sections would not prevent cardiac overload Concern that cesarean section would increase risk of maternal infection if presence of significant immunosuppression Pregnancy complications Hypertension Common in renal and hepatic transplant patients before and during pregnancy (50–75% incidence) Aggressive management required: Early use of antihypertensive medications when mild hypertension arises Methyldopa is the antihypertensive agent of choice followed by alpha and beta blockers, calcium channel blockers, and thiazides. Blood pressure should be kept close to normal May lead to fetal growth restriction Preeclampsia Difficult to diagnose due to high incidence of preexisting hypertension and proteinuria Approximately three to four times more common than in general population May lead to higher rates of cesarean delivery Hemolysis elevated liver enzymes, lower platelets (HELLP) syndrome in hepatic patients may be difficult to diagnose Elevation of liver enzymes may be due to HELLP or due to progression of hepatic disease Preterm delivery (<37 weeks gestation) Common: Up to 50% of infants are born premature Mean gestational age at delivery in renal transplant patients: 34 weeks As a result, have complications of premature delivery, especially those at < 34 weeks gestation Neonatal death Cerebral palsy Blindness, deafness Learning disabilities, low intelligence quotients Urinary tract infections Common in female transplant recipients with an increased risk during pregnancy. Low birth weight (<2500 g) Up to 20% of infants May lead to early delivery Increased incidence partially due to increased risk of hypertensive disorders Serial sonograms to monitor fetal growth recommended Graft rejections Difficult to detect: acute rejection rates during pregnancy/postpartum period range from 9% to 15% Must maintain immunosuppression to avoid rejection Acute rejection associated with poorer pregnancy outcomes and recurrent rejection episodes after delivery Lung transplant patients have higher rate of rejection for unknown reasons Three factors most associated with rejection: history of medically ... Your MyAccess profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth