Successful Pregnancies in Women Treated by Dialysis and Kidney Transplantation

,

doi:10.1111/j.1471-0528.1980.tb04434.x

Cited by 224 publications

(3 citation statements)

References 34 publications

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“…Moreover, immunosuppression therapy that blocks adaptive immune responses in transplant patients does not interfere with pregnancy (128,129). Effects of immunosuppression on parturition are not known since most women with solid organ transplants are delivered by Cesarean section (130). Thus, current evidence focuses on macrophages to mediate inflammation in the structural remodeling process as informed by paracrine factors produced by stromal fibroblasts that integrate progesterone and other signals at the external fetal-maternal interface.…”

Section: Schema For Cervix Transformation From Soft To Ripe To Dilatimentioning

confidence: 99%

Immunobiology of Cervix Ripening

Yellon

2020

Front. Immunol.

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The cervix is the essential gatekeeper for birth. Incomplete cervix remodeling contributes to problems with delivery at or post-term while preterm birth is a major factor in perinatal morbidity and mortality in newborns. Lack of cervix biopsies from women during the period preceding term or preterm birth have led to use of rodent models to advanced understanding of the mechanism for prepartum cervix remodeling. The critical transition from a soft cervix to a compliant prepartum lower uterine segment has only recently been recognized to occur in various mammalian species when progesterone in circulation is at or near the peak of pregnancy in preparation for birth. In rodents, characterization of ripening resembles an inflammatory process with a temporal coincidence of decreased density of cell nuclei, decline in cross-linked extracellular collagen, and increased presence of macrophages in the cervix. Although a role for inflammation in parturition and cervix remodeling is not a new concept, a comprehensive examination of literature in this review reveals that many conclusions are drawn from comparisons before and after ripening has occurred, not during the process. The present review focuses on essential phenotypes and functions of resident myeloid and possibly other immune cells to bridge the gap with evidence that specific biomarkers may assess the progress of ripening both at term and with preterm birth. Moreover, use of endpoints to determine the effectiveness of various therapeutic approaches to forestall remodeling and reduce risks for preterm birth, or facilitate ripening to promote parturition will improve the postpartum well-being of mothers and newborns. The maternal immune system in mammals adapts to tolerate the differentiation of novel structures associated with the fetal allograft. Development of two interfaces protect the fetus from rejection and assault by the ecology of the external environment. The internal fetal-maternal interface, as represented by the fetal membranes, placenta, and decidua, is crucial for maintaining maternal inflammatory reactivity for surveillance and responses to pathogens. Discussion of the internal interface is elsewhere and in this special volume (1-3). However, the present review is focused on the external fetal-maternal interface consisting of an amniotic fluid buffer, in a forebag region later in pregnancy as the fetal head engages the lower uterus, and the fetal membranes as they press against the internal os of the cervix. This description of a singleton pregnancy in primates near term applies to rodents, despite anatomical differences in the uterus described below, because observations indicate a single fetal sac engages the internal os of the cervix shortly before labor. The success of this external interface to fend off the biome and virome in the vagina reflects the barrier function of the cervix to protect both the fetus and maternal host structures in the uterus. The cervix barrier function has both immunological and structural components. One part of the mate...

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Section: Schema For Cervix Transformation From Soft To Ripe To Dilatimentioning

confidence: 99%

Immunobiology of Cervix Ripening

Yellon

2020

Front. Immunol.

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“…Early reports demonstrated high rates of maternal morbidity, including severe uncontrolled hypertension, preeclampsia, hemolysis, elevated liver enzymes and low platelets syndrome as well as the need for frequent blood transfusions [22]. Women managed with intensified hemodialysis have improved blood pressure control and lower transfusion requirements [19, 20].…”

Section: Pregnancy Outcomesmentioning

confidence: 99%

Pregnancy and End-Stage Renal Disease

2018

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Pregnancy is uncommon in women with end-stage renal disease (ESRD). Fertility rates are low in women on dialysis, and physicians still frequently counsel women with ESRD against pregnancy. Advancements in the delivery of dialysis and obstetric care have led to improved live birth rates in women on dialysis, so pregnancy for young women with ESRD is now more feasible and safer. However, these pregnancies remain high-risk for both maternal and fetal complications, necessitating experienced multidisciplinary care. In this article, we review fertility issues in women with ESRD, discuss pregnancy outcomes in women on dialysis, and provide an approach for management of pregnant women with ESRD.

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“…Although HD patients maintain their pregnancies, maternal and fetal complications are common. First pregnancy reports of successful live birth rates in HD patients were extremely low [18]. These rates increased up to 50% in the 2000s because of the advancement of dialysis efficacy [19].…”

Section: Discussionmentioning

confidence: 99%

Pregnancy and its outcomes in hemodialysis patients in Turkey

Dheir¹,

Güngör²,

Ulu³

et al. 2021

Turk J Med Sci

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Pregnancy and its outcomes in hemodialysis patients in TurkeyBackground/aim: This study aimed to investigate pregnancy frequency and evaluate the factors affecting live births in hemodialysis (HD) patients. Materials and methods:Female HD patients whose pregnancy was retrospectively reported between January 1, 2014, and December 31, 2019. The duration of HD, primary disease, whether the pregnancy resulted in abortion, stillbirth, or live birth, whether the HD duration was prolonged after diagnosing the pregnancy and whether it accompanied preeclampsia were recorded. Results:In this study, we reached 9038 HD female patients' data in the study. A total of 235 pregnancies were detected in 145 patients. The mean age was 35.42 (35 ± 7.4) years. The mean age at first gestation was 30.8 ± 6.5 years. The average birth week was 32 (28 -36) weeks. 53.8% (no = 78) of the patients had live birth, 51.7% (no = 70) had at least one abortion in the first 20 weeks, and 13.1% (no = 19) had at least one stillbirth after 20 weeks. The rate of patients' increased numbers of dialysis sessions during pregnancy was 71.7%. The abortion rate was 22.4% in those with increased HD sessions, whereas 79.3% in those not increased HD sessions (p < 0.001). Live birth frequency was 67.2% in the increased HD sessions group and 3.4% in those who did not differ in HD sessions (p < 0.001). Conclusion:For the first time, we reported pregnancy outcomes in HD female patients, covering all regions of Turkey. It has been observed that; increasing the number of HD sessions in dialysis patients will decrease fetal and maternal complications and increase live birth rates.

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Successful Pregnancies in Women Treated by Dialysis and Kidney Transplantation

Cited by 224 publications

References 34 publications

Immunobiology of Cervix Ripening

Immunobiology of Cervix Ripening

Pregnancy and End-Stage Renal Disease

Pregnancy and its outcomes in hemodialysis patients in Turkey

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