Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

5-Solid Organ Transplantation In Pregnancy Tog > Tog > Flashcards

Tog Flashcards

1
Q

What is the prevalence of renal transplantation in UK?

A

2-6 /10 000
30- 40 pregnancies/ year

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the risk of acute rejection of renal transplantation in the first year?

A

10- 15 % and is associated with recipients under the age of 45 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What pregnancy counseling for renal transplant recipient 1 year after transplantation with normal eGFr?

A

Can be reassured that there is no conclusive evidence that pregnancy will increase their risk of graft rejection , or cause a deterioration in their graft function.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What medication should be stopped before pregnancy in renal transplant recipient? When? Why?

A
  • Mycophenolate mofetil - can be switched to azathioprine
  • 3 month
  • 1- wash out period prior to pregnancy
    2- allows confirmation of graft stability
    3- can be used for prepregnancy folate administration ( 400 mcg/ d)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Among medications that commonly prescribed in solid organ transplant recipients … which is considered to be safe in breastfeeding?

A

Azathioprine
Cyclosporine
Tacrolimus
Hydroxychloroquine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Among medications that commonly prescribed in solid organ transplant recipients … which is considered to be teratogenic in pregnancy?

A

Mycophenolate
ACE inhibitors
Angiotensin receptor antagonist
Warfarin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the prevalence of hypertension among pregnant women with renal transplantat?

A

More than 50 %

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

In women with renal transplants who don’t require antihypertensives outside of pregnancy, how many of them will commence treatment for hypertension during pregnancy?

A

16 % of them

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

In renal transplant recipients which facilitates the detection of an increase in proteinuria after 20 weeks of gestation in the context of diagnosing PET?

A

Quantification of proteinuria in early pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What medications commonly prescribed in renal transplant recipients that have diabetogenic effects? What is the occurrence rate?

A

1- Calcineurin inhibitors ( tacrolimus- cyclosporine)
2- prednisolone
🔴 estimated to occur in 4- 25% of renal transplant recipients.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Why is CS rates higher in pregnant women with renal transplants ?

A

Consequence of PET and / or FGR
Leading to iatrogenic preterm delivery.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Is renal transplantation a contraindication to vaginal delivery?

A

No

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Neonatal outcomes in women with renal transplants are a composite product of what?

A

PET / FGR / prematurity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the effect of renal transplantation on pregnancy?

A

1-⬆️ PET 30-40%
2-⬆️ CS
3-⬆️ neonatal unit admissions
4-⬆️ ectopic pregnancy
5-GDM
6- preterm delivery
7- ⬇️ birth weight
8- ⬇️ gestational age
9- infection: UTI 30-40%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the most common cause of creatinine rising in pregnant women with renal transplants?

A

PET

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the rate of acute rejection during pregnancy in women with renal transplants?

A

In UK 2%
Meta-analysis 4.2%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What to do if graft rejection is suspected in pregnancy?

A

Graft biopsy
Less difficult than native biopsy
More bleeding in pregnancy

18
Q

Transplant rejection can be treated in pregnancy with…..

A

1-Corticosteroid
2-Optimization of tacrolimus/cyclosporine
3- biological agents

19
Q

What cautions should be taken about Babies exposed to biologic drugs in utero ?

A

Avoid live vaccines ( tuberculosis rotavirus- live attenuated influenza- oral polio - typhoid - yellow fever- varicella- measles- mumps- rubella)
🔴 during the first 6 months of life

20
Q

In addition to routine first trimester investigations what to check in pregnant women with renal transplant recipients ?

A

CBC
Renal function / liver function
Ca / phosphate
Albumin
24h urine protein: cr ratio
Mid stream urine sample for culture

21
Q

What to expect about proteinuria in pregnancy in women with renal transplants?

A

To double.
Further doubling if the woman was taking an ACEi ot ARA prior to pregnancy when these teratogenic drugs are discontinued.

22
Q

When to consider LMWH prophylaxis in pregnant women with renal transplants?

A

Urinary protein: creatinine ratio
> 300 mg / mmol. ( Normal less than 15)
Or
Urinary albumin: creatinine ratio
> 180 mg / mmol (normal less than 3)

23
Q

What to consider about serological screening for chromosomal trisomy in pregnant women with renal transplants?

A

There is a possibility of false positive result /affected by renal excretion of Bhcg./

24
Q

What is the frequency of monitoring renal function during pregnancy in pregnant women with renal transplants?

A

Monthly

25
Q

What are the drugs that can lead to calcineurin inhibitors toxicity ( cyclosporine/ tacrolimus)?

A

Erythromycin
Clarithromycin

26
Q

How much the increase of erythropoietin concentration in normal pregnancy?

A

2-4 folds

27
Q

When to consider treatment with erythropoietin stimulating agents during pregnancy in women with renal transplants?

A

In iron replete anaemic women

28
Q

When to discuss the mode of delivery in women with renal transplants?

A

30- 34 weeks of gestation
By : obstetric and transplant surgical team

29
Q

What criteria should be suggestive of superimposed preeclampsia in pregnant women with renal transplants?

A

1- development of new proteinuria after 20 weeks.
2- an increase in BP to more than 160/110.
3- an increase in treatment to maintain BP < 160/110.
4- 100% increase in proteinuria
5- elevated transaminases / thrombocytopenia/ FGR.
6- ⬇️ placental growth factor

30
Q

How to adjust mg sulfate dose in pregnant women with renal transplants with PET?

A

🔴Loading dose (4g) is given irrespective of renal function
🔴 maintenance infusion levels are halved in those with:
1- significant renal impairment
2- oliguria
🔴 mgso4 serum concentration can be checked at 4- 6 hours
Maintain concentration < 3.5 mmol/L

31
Q

Intrapartum management of renal transplant recipients?

A

🔴 vaginal delivery is recommended
🔴 continuous CTG
🔴 oxytocin/ prostaglandin are safe

32
Q

What is the risk of trauma to renal graft at CS? How to lower this risk?

A

1-2%
By midline skin incision

33
Q

How to manage women with renal transplants who are taking prednisolone daily during labour?

A

They require IV hydrocortisone
( 50-100 mg / 6-8 hours) until they are able to tolerate oral medication.

34
Q

What to monitor in renal transplant recipients Prior to discharge from the hospital after delivery?

A

BP should be stable
Less than 140/90

35
Q

What contraceptions are preferred for women with renal transplants?

A

Progesterone only pills
Mirena
Progesterone implants

36
Q

What are the recommendations about kidney donors in pregnancy?

A

Aspirin prophylaxis
Because the doubling of the risk of gestational hypertension

37
Q

What is the prevalence of acute rejection in liver transplant recipients during pregnancy?

A

2-17%
Graft loss within 2 years of pregnancy: 10.5 %

38
Q

The increase risk of PET in all solid organ transplant recipients warrants what?

A

Aspirin prophylaxis

39
Q

What are the criteria for considering pregnancy after renal transplantation safe?

A

❤ wait 2 years after transplantation

1- no rejection in the previous year
2- graft function should be stable
( cr < 1.5 mg / dl)
3- no or minimal proteinuria
( < 500 mg / 24 h)
4- should be on stable dosage of immunosuppression
5- no infection that can affect the fetus ( cmv)
6- co morbidity conditions should be assessed and managed
7- normal BP or minimal hypertensive Rx.

40
Q

What are the clinical signs of renal transplant acute rejection in pregnancy?

A

Fever/ oliguria/ renal enlargement

41
Q

What is the frequency of antenatal visits in women with renal transplants?

A

Every 2 weeks;
* UTI / each visit
* BP - proteinuria/ each visit
* RF - serum levels of cyclosporine and tacrolimus/ 4 weeks
* screen for GDM / anemia/ graft rejection

42
Q

What is the mechanism of action for calcineurin inhibitors?

A

Calcineurin inhibitorsare medicines which inhibit the action of calcineurin. Calcineurin is an enzyme that activates T-cells of the immune system.

5-Solid Organ Transplantation In Pregnancy Tog (1 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions