AETIOLOGY, MATERNAL AND FOETAL OUTCOME IN 60 CASES OF OBSTETRICAL ACUTE RENAL FAILURE
AbstractBackground: Acute renal failure is a serious complication in pregnancy. Not only does it result insignificant maternal morbidity and mortality but also results in significant number of foetal loss.Although incidence of obstetrical acute renal failure has decreased in developed countries but still itis one of the major health problem of developing nations. The objective of this study was to studyaetiology, maternal and foetal outcome in obstetrical acute renal failure. Methods: This study wasconducted at Department of Nephrology, Khyber Teaching Hospital, Peshawar from August 2006 toDecember 2007. It was a descriptive, case series study. Female patients with pregnancy and acuterenal failure, irrespective of age, were included in the study. Patients were thoroughly examined andbaseline urea, creatinine, serum electrolytes, peripheral smear, prothrombin time, partialthromboplastin time, fibrinogen degradation products, renal and obstetrical ultrasound wereperformed on each patient and 24-hr urinary protein and bacterial culture sensitivity on blood, urineor vaginal swabs were done in selected patients. Foetal and maternal outcome were recorded. Datawere analysed using SPSS. Results: A total of 60 patients were included in the study. Mean age ofthe patients was 295.4 years and duration of gestation was 334.9 weeks. Mean gravidity was42.2. Sixteen patients (26.66%) were treated conservatively while 44 (73.33%) required dialysis.Postpartum haemorrhage was present in 14 (23.33%), postpartum haemorrhage and disseminatedintravascular coagulation (DIC) in 11 (18.33%), eclampsia-preeclampsia in 8 (13.33%), antepartumhaemorrhage in 8 (13.33%), antepartum haemorrhage with DIC in 6 (10%), DIC alone in 4 (6.66%),obstructed labour in 3 (5%), septic abortion in 3 (3.33%), HELLP (haemolysis elevated liver enzymeand low platelet) in 2 (3.33%), urinary tract infection with sepsis in 1 (1.66%) and puerperal sepsis in1 (1.66%). Foetal loss was 40 (66.66%). Maternal mortality was 9 (15%) while 28 (46.66%) fullyrecovered. Among the rest 6 (30%) had partial recovery and 5 (8.33%) had dialysis dependentchronic kidney disease. Conclusion: Obstetrical acute renal failure not only results in foetal loss butalso causes significant maternal morbidity and mortality.Keywords: Obstetrical acute renal failure, ARF, Aetiology, Foetal outcome, Maternal outcome
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