Title TRUDNOĆA NAKON TRANSPLANTACIJE BUBREGA
Title (english) PREGNANCY AFTER KIDNEY TRANSPLANTATION
Author Nina Hanžič
Mentor Lidija Orlić (mentor)
Committee member Ivan Bubić (predsjednik povjerenstva)
Committee member Dean Markić (član povjerenstva)
Committee member Sanjin Rački (član povjerenstva)
Granter University of Rijeka Faculty of Medicine (Department of Internal Medicine) Rijeka
Defense date and country 2018-07-13, Croatia
Scientific / art field, discipline and subdiscipline BIOMEDICINE AND HEALTHCARE Clinical Medical Sciences Urology
Scientific / art field, discipline and subdiscipline BIOMEDICINE AND HEALTHCARE Clinical Medical Sciences Gynecology and Obstetrics
Abstract Transplantacija bubrega pruža najbolju nadu za žene koje su u završenom stadiju bubrežne bolesti i žele postati trudne. Njih treba savjetovati prije i nakon transplantacije o kontracepciji, vremenu kada započeti s trudnoćom, teratogenim učincima lijekova, te njihovoj zamjeni s onima koji su sigurni tijekom trudnoće. Trudnoća bi se trebala odgoditi barem godinu dana nakon transplantacije da se smanje rizici za pojavu komplikacija kod trudnice i fetusa. Imunosupresivni lijekovi koji se smatraju sigurnima tijekom trudnoće jesu inhibitori kalcineurina (ciklosporin, takrolimus), azatioprin i niske doze prednizona. Liječenje mikofenolatom i sirolimusom treba biti prekinuto šest tjedana prije začeća. Čimbenici koji su povezani s lošim ishodima trudnoće jesu hipertenzija, kreatinin >1,4 mg/dL (124 μmol/L), te proteinurija. Komplikacije koje se najčešće javljaju i vezane su uz trudnice jesu hipertenzija, preeklampsija te infekcije. Glavne komplikacije kod fetusa jesu intrauterini zastoj u rastu, niska porođajna težina i prijevremeni porod. Po trenutnim smjernicama preporuča se vaginalni porod, a carski rez samo ako postoje indikacije za njega. U praćenje trudnice trebaju biti uključeni transplantacijski nefrolog, opstetričar neonatolog, jer su te trudnoće visokorizične. Dojenje nije kontraindicirano ako se uzimaju lijekovi koji su se uzimali tijekom trudnoće. Trudnoća ne povećava veću rizik od odbacivanja presatka ako je trudnoća bez rizičnih čimbenika.
Abstract (english) Kidney transplantation offers best hope to women with end stage renal disease and want to be pregnant. It is recommended that women in childbearing age should recieve before and after kidney transplantation contraception counseling, and counseling about teratogenic immunosuppressive drugs which must be replaced with immunosuppresivess which are consideres safe during pregnancy. Pregnancy should be avoided in the first year after transplantation, to reduce the risk of maternal and fetal complications. Immunosuppressive drugs, such as calcineurin inhibitors (cyclosporine, tacrolimus), azathioprine and low dose prednisone are considered safe during pregnancy. Mycophenolate mofetil and sirolimus should be stopped 6 weeks before conception. The factors associated with poor pregnancy outcomes include hypertension, serum creatinine >1,4 mg/dL and proteinuria. Maternal complications that occur more commonly than the general population include hypertension, pree-eclampsia and infections. Fetal complications that occur more commonly than the general population include intrauterine growth retardation, low birth weight, premature birth. In the current guidelines vaginal delivery is recommended for most transplant recipient, cesarean section should be done for obstetric indications. Pregnant women should be followed up by a transplant nephrologist, obstetrician and neonatologist, because these pregnancies are high risk. Breast-feeding is not contraindicated if they are the same as they been during pregnancy. Pregnancy without risk factors not increased the risk of transplant rejection.
Keywords
hipertenzija
infekcije
intrauterini zastoj u rastu
niska porođajna težina
odbacivanje transplantata
preeklampsija
prijevremeni porod
transplantacija bubrega
trudnoća
Keywords (english)
hypertension
infections
intrauterine growth retardation
low birth weight
kidney transplantation
preterm delivery
preeclamsia
rejection
Language croatian
URN:NBN urn:nbn:hr:184:948359
Study programme Title: Medicine Study programme type: university Study level: integrated undergraduate and graduate Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
Type of resource Text
File origin Born digital
Access conditions Open access
Terms of use
Created on 2018-11-22 17:30:39