Maternal-Perinatal Variables in Patients with Severe Preeclampsia Who Develop Acute Kidney Injury.

Introduction: At present, we are witnessing an increase in preeclampsia, especially the most severe forms, which are associated with an increased risk of maternal-perinatal morbidity and mortality. As a severity criterion, acute kidney injury (AKI) has been associated with a worse prognosis, and for this reason, the maternal and perinatal variables associated with AKI in patients with severe preeclampsia (SP) were analysed in this study. Methods: An observational, retrospective, single-centre study of patients with SP treated at a tertiary hospital between January 2007 and December 2018 was conducted. The case criteria based on the criteria established by the ACOG Practice Guidelines for Gestational Hypertension and Preeclampsia. AKI is considered when serum creatinine exceeds 1.1 mg/dL in a pregnant woman with previously normal renal function. In patients with existing chronic kidney disease (CKD), it is referred to as AKI if the baseline serum creatinine increases by 1.5 fold. Pregestational, gestational and postpartum variables were analysed up to 12 weeks postpartum using univariate and multivariate logistic regression analysis. Results: During the study period, 76,828 births were attended, and 303 pregnant women were diagnosed with SP. The annual incidence of SP increased gradually throughout the study period, reaching 1.79/100 births/year in 2018. Acute kidney injury (AKI) occurred in 24.8% of the patients. The multivariate analysis revealed an increased association with a history of previous CKD, the use of assisted reproductive techniques and caesarean section. Uric acid and thrombotic microangiopathy (TMA) had a high correlation with AKI. Indications for caesarean section are associated with AKI in SP. Regarding perinatal outcomes in cases of AKI, there was a higher percentage of neonates who required foetal lung maturation with steroids and an increased need for NICU admission. No case of maternal death was recorded; however, an increase in neonatal mortality was found among patients who did not develop AKI. After 12 weeks postpartum, 72 patients were referred to the nephrology consultation for persistent hypertension, proteinuria or renal failure. Conclusions: In preeclampsia, AKI is a common complication, especially among patients with a history of CKD, those who became pregnant using assisted reproduction techniques and those who delivered via caesarean section. The perinatal impact of AKI is mainly centred on a higher rate of NICU admission and a lower mortality rate. Among biochemical and haematological markers, the uric acid level prior to renal failure has a direct and significant correlation with the risk of AKI, as does the development of TMA in patients with preeclampsia. Therefore, the monitoring of renal function in cases of preeclampsia should be strict, and referral for a nephrology consultation may be necessary in some cases.

Maternal Perinatal Characteristics in Patients with Severe Preeclampsia: A Case-Control Nested Cohort Study.

Preeclampsia is one of the most worrisome complications during pregnancy, affecting approximately 1 out of 20 women worldwide. Preeclampsia is mainly characterized by a sustained hypertension, proteinuria, also involving a significant organ dysfunction. Moreover, 25% of the cases could be classified as severe preeclampsia (SP), a serious condition that could be life-threatening for both the mother and fetus. Although there are many studies focusing on preeclampsia, less efforts have been made in SP, frequently limited to some specific situations. Thus, the present study aims to conduct a comparative analysis of risk factors, maternal characteristics, obstetric and neonatal outcomes and maternal complications in patients with severe preeclampsia versus patients without severe preeclampsia. Hence, 235 cases and 470 controls were evaluated and followed in our study. We described a set of variables related to the development of severe preeclampsia, including maternal age > 35 years (69.8%), gestational (26.8%) or chronic arterial hypertension (18.3%), obesity (22.6%), use of assisted reproduction techniques (12.3%), prior history of preeclampsia (10.2%) and chronic kidney disease (7.7%) All patients had severe hypertension (>160 mmHg) and some of them presented with additional complications, such as acute renal failure (51 cases), HELLP syndrome (22 cases), eclampsia (9 cases) and acute cerebrovascular accidents (3 cases). No case of maternal death was recorded, although the SP group had a higher cesarean section rate than the control group (60% vs. 20.9%) (p < 0.001), and there was a notably higher perinatal morbidity and mortality in these patients, who had a prematurity rate of 58.3% (p < 0.001) and 14 perinatal deaths, compared to 1 in the control group. Overall, our study recognized a series of factors related to the development of SP and related complications, which may be of great aid for improving the clinical management of this condition.

Resumption of intercourse, self-reported decline in sexual intercourse and dyspareunia in women by mode of birth: A prospective follow-up study.

AIM: To evaluate the association between mode of birth and the resumption of sexual intercourse, self-reported decline in sexual intercourse and dyspareunia in women at the 6th week and 6th month postpartum. BACKGROUND: Interest in the relationship between mode of birth and postpartum sexual functioning is increasing. However, previous findings are contradictory. DESIGN: Prospective, longitudinal, observational study. METHOD: The participants comprised 552 healthy primiparous women aged 18-45 years who gave birth at a hospital between February 2013 - April 2014. Interviews were performed at the hospital and via telephone at the 6th week and 6th month postpartum. We constructed multivariate logistic regression models to examine the relationship between mode of birth and resumption of intercourse, self-reported decline in sexual intercourse and dyspareunia at the 6th week and 6th month postpartum. RESULTS: At the 6th week postpartum, forceps-assisted birth, combination of episiotomy plus perineal tear and belonging to a higher socio-economic status were related to a higher risk of non-resumption of sexual intercourse, while breastfeeding was related to a higher probability of dyspareunia. At the 6th month postpartum, the likelihood of self-reported decline in sexual intercourse was higher among women who screened positive for postpartum depression and a higher number of breastfeeding women reported a decline in sexual intercourse and dyspareunia. Furthermore, at the 6th month postpartum, women who reported the use of emergency services for a health problem had a higher risk of not having resumed intercourse and of experiencing dyspareunia.

Health related quality of life of women at the sixth week and sixth month postpartum by mode of birth.

BACKGROUND: Health-related quality of life of women in the postpartum period may depend on the mode of birth. However, previous findings are contradictory. AIM: To explore health-related quality of life of women at the sixth week and sixth month postpartum by mode of birth. METHODS: We performed a longitudinal prospective study in Spain that included 546 healthy primiparae aged 18 to 45 years who gave birth to a healthy newborn. At the sixth week and sixth month postpartum, we analysed sociodemographic and clinical characteristics and compared health-related quality of life (measured using the SF-36) by mode of birth (normal vaginal, forceps, vacuum-extraction, elective caesarean section, emergency caesarean section). In addition, we analysed the change in health-related quality of life between the two time points for each mode of birth. FINDINGS: We did not find differences in health-related quality of life by mode of birth at the sixth week or sixth month postpartum. At the sixth week postpartum, regardless of the mode of birth, women with postpartum urinary incontinence reported lower health-related quality of life. Between the sixth week and sixth month postpartum, health-related quality of life improved for all modes of birth. CONCLUSION: While mode of birth is not directly associated with health-related quality of life, it does have an indirect relationship in the short term. Women who reported the lowest health-related quality of life were those with postpartum urinary incontinence. Most women with postpartum urinary incontinence were in the forceps group.

Quality of life of mothers at the sixth week and sixth month post partum and type of infant feeding.

INTRODUCTION: there is little scientific evidence on the relationship between maternal quality of life and type of infant feeding. The purpose of this study was to determine if there were differences in mother's quality of life by type of infant feeding. MATERIAL AND METHODS: longitudinal prospective study with 364 women who gave birth at a public hospital at Madrid, Spain, between February and October 2013. To be included, the participants had to be a healthy primigravida aged 18-45 years who gave birth to a healthy newborn with a gestational age between 36 and 42 completed weeks, regardless of birth type. The hospital interviews were performed between 36 and 48 hours post partum in women who had case of vaginal/instrumental births and 60-72 hours post partum for women who had a caesarean birth. Telephone interviews were conducted at the sixth week and sixth month post partum, and included the SF-36 to measure quality of life. SF-36 scores were compared between breast feeding and artificial milk feeding. We also analysed the longitudinal change in SF-36 scores in both groups. RESULTS: at the sixth week post partum, regardless of the infant feeding modality, an increased mental health score was recorded for mothers who reported that their children ate and slept well and for those who did not go to the emergency hospital service because of concern over their baby's health. No significant differences in quality of life were found between the two groups at six months post partum. Between the sixth week and sixth month post partum, quality of life improved significantly in both groups. DISCUSSION: at the sixth week post partum, the proportion of children who ate and slept well and did not have to attend in an emergency hospital service was higher in the breast feeding group. This observation was associated with greater maternal quality of life. This positive indirect relationship between breast feeding and quality of life should be considered an additional maternal health benefit in the short term.