Solid organ transplant in pregnancy TOG

Question 1

For how long after renal transplant is conception not advised? What is the risk of rejection during this time?

Answer 1

1 year
10-15% chance of rejection if <45yrs

Question 2

Following 1 year what are the risk of pregnancy dependant on?

Answer 2

Level of graft function
Co-exisiting HTN or proteinuria
Reason for transplant e.g. diabetic - neuropathy and retinopathy

Question 3

Which medications used in transplant are teratogenic?

Answer 3

Mycophenolate
ACEi
ARB
Warfarin

Question 4

When should mycophenolate be stopped, what can it be switched to?

Answer 4

3 months pre pregnancy
Change to azathioprine
Give folic acid

Question 5

What proportion of women with renal transplants not on antihypertensives will need to commence antihypertensives in pregnancy?

Answer 5

16%

Question 6

In renal transplant, how often measure BP

Answer 6

Every 2 weeks

Question 7

How often to measure FBC/MSU screening

Answer 7

Monthly

Question 8

How often to monitor renal function

Answer 8

4-6 weeks to detect rejection

Question 9

How often to test for CMV/herpes>

Answer 9

2 x in pregnancy

Question 10

Pre pregnancy urinary protein loss above what level Is associated with loss of maternal renal function after pregnancy?

Answer 10

> 1g/day

Question 11

When to switch ACEi/ARB?

Answer 11

At +ve pregnancy test

Question 12

Women with renal transplant are more likely in pregnancy:

Answer 12

PET - give aspirin
CS
Preterm delivery
SGA
Admission to NNU

Question 13

Most pregnancy complication with renal transplant?

Answer 13

Preterm delivery <37 weeks

Question 14

At which urine PCR/albumin:creatinie ration should LMWH be considered?

Answer 14

Urine PCR > 300
A:C ration >180

Proteinuria x 2 in pregnancy, x 4 if stopping ACEi/ARB

Question 15

What growth USS should be offered

Answer 15

12 weeks, 20 weeks, 26-28, 32-34

Question 16

How is serological testing for chromosomal trisomy effected

Answer 16

b-hCG - false +ve risk fur to poor renal excretion

Question 17

Intrapartum management of renal transplant

Answer 17

Obstetric unit
CTG
Aim VD unless obstetric reasons
Can use prostaglandins and oxytocin
If >7.5mg pred - need IV hydrocortisone in labour

Question 18

Risk of trauma to renal graft at CS?

Answer 18

1-2%, consider midline incision to reduce risk to allograft

Question 19

Which contraceptives can be used in women with renal transplant?

Answer 19

POP
Mirena
Implant

Question 20

PP antihypertensive in women with renal transplant

Answer 20

Ensure BP stable and lower than 140/90
Swap to OD or BD medication - ACEi e.g. enalapril