AETIOLOGY, MATERNAL AND FOETAL OUTCOME IN 60 CASES OF OBSTETRICAL ACUTE RENAL FAILURE

Muhammad Abdul Mabood Khalil, Amer Azhar, Nisar Anwar, Amin ullah, Najm -ud- Din, Raj Wali

Abstract


Background: Acute renal failure is a serious complication in pregnancy. Not only does it result in
significant 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 it
is one of the major health problem of developing nations. The objective of this study was to study
aetiology, maternal and foetal outcome in obstetrical acute renal failure. Methods: This study was
conducted at Department of Nephrology, Khyber Teaching Hospital, Peshawar from August 2006 to
December 2007. It was a descriptive, case series study. Female patients with pregnancy and acute
renal failure, irrespective of age, were included in the study. Patients were thoroughly examined and
baseline urea, creatinine, serum electrolytes, peripheral smear, prothrombin time, partial
thromboplastin time, fibrinogen degradation products, renal and obstetrical ultrasound were
performed on each patient and 24-hr urinary protein and bacterial culture sensitivity on blood, urine
or vaginal swabs were done in selected patients. Foetal and maternal outcome were recorded. Data
were analysed using SPSS. Results: A total of 60 patients were included in the study. Mean age of
the patients was 295.4 years and duration of gestation was 334.9 weeks. Mean gravidity was
42.2. Sixteen patients (26.66%) were treated conservatively while 44 (73.33%) required dialysis.
Postpartum haemorrhage was present in 14 (23.33%), postpartum haemorrhage and disseminated
intravascular coagulation (DIC) in 11 (18.33%), eclampsia-preeclampsia in 8 (13.33%), antepartum
haemorrhage 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 enzyme
and low platelet) in 2 (3.33%), urinary tract infection with sepsis in 1 (1.66%) and puerperal sepsis in
1 (1.66%). Foetal loss was 40 (66.66%). Maternal mortality was 9 (15%) while 28 (46.66%) fully
recovered. Among the rest 6 (30%) had partial recovery and 5 (8.33%) had dialysis dependent
chronic kidney disease. Conclusion: Obstetrical acute renal failure not only results in foetal loss but
also causes significant maternal morbidity and mortality.
Keywords: Obstetrical acute renal failure, ARF, Aetiology, Foetal outcome, Maternal outcome

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